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Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival

Iliff, Peter Ja; Piwoz, Ellen Gb; Tavengwa, Naume Va; Zunguza, Clare Dc; Marinda, Edmore Ta; Nathoo, Kusum Jd; Moulton, Lawrence He; Ward, Brian Jf; the ZVITAMBO study group; Humphrey, Jean Ha,e

doi: 10.1097/01.aids.0000166093.16446.c9
Epidemiology and Social

Objectives: The promotion of exclusive breastfeeding (EBF) to reduce the postnatal transmission (PNT) of HIV is based on limited data. In the context of a trial of postpartum vitamin A supplementation, we provided education and counseling about infant feeding and HIV, prospectively collected information on infant feeding practices, and measured associated infant infections and deaths.

Design and methods: A total of 14 110 mother–newborn pairs were enrolled, randomly assigned to vitamin A treatment group after delivery, and followed for 2 years. At baseline, 6 weeks and 3 months, mothers were asked whether they were still breastfeeding, and whether any of 22 liquids or foods had been given to the infant. Breastfed infants were classified as exclusive, predominant, or mixed breastfed.

Results: A total of 4495 mothers tested HIV positive at baseline; 2060 of their babies were alive, polymerase chain reaction negative at 6 weeks, and provided complete feeding information. All infants initiated breastfeeding. Overall PNT (defined by a positive HIV test after the 6-week negative test) was 12.1%, 68.2% of which occurred after 6 months. Compared with EBF, early mixed breastfeeding was associated with a 4.03 (95% CI 0.98, 16.61), 3.79 (95% CI 1.40–10.29), and 2.60 (95% CI 1.21–5.55) greater risk of PNT at 6, 12, and 18 months, respectively. Predominant breastfeeding was associated with a 2.63 (95% CI 0.59–11.67), 2.69 (95% CI 0.95–7.63) and 1.61 (95% CI 0.72–3.64) trend towards greater PNT risk at 6, 12, and 18 months, compared with EBF.

Conclusion: EBF may substantially reduce breastfeeding-associated HIV transmission.

From the aZVITAMBO Project, Borrowdale, Harare, Zimbabwe

bThe SARA Project, Academy for Educational Development, Washington, DC, USA

cThe Harare City Health Department, Harare, Zimbabwe

dThe University of Zimbabwe College of Health Sciences, Harare, Zimbabwe

eThe Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA

fThe Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.

Received 18 May, 2004

Revised 4 November, 2004

Accepted 18 January, 2005

Correspondence and reprint requests to Jean Humphrey, ZVITAMBO Project, 1 Borrowdale Road, Borrowdale, Harare, Zimbabwe. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.