Coovadia, H.M., Rollins, N.C., Bland, R.M., Little, K., Coutsoudis, A., Bennish, M.L. and Newell, M.-L. (2007) Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet, 369(9567), pp. 1107-1116. (doi: 10.1016/S0140-6736(07)60283-9)
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Abstract
<p>Background: Exclusive breastfeeding, though better than other forms of infant feeding and associated with improved child survival, is uncommon. We assessed the HIV-1 transmission risks and survival associated with exclusive breastfeeding and other types of infant feeding.</p> <p>Methods: 2722 HIV-infected and uninfected pregnant women attending antenatal clinics in KwaZulu Natal, South Africa (seven rural, one semiurban, and one urban), were enrolled into a non-randomised intervention cohort study. Infant feeding data were obtained every week from mothers, and blood samples from infants were taken monthly at clinics to establish HIV infection status. Kaplan-Meier analyses conditional on exclusive breastfeeding were used to estimate transmission risks at 6 weeks and 22 weeks of age, and Cox's proportional hazard was used to quantify associations with maternal and infant factors.</p> <p>Findings: 1132 of 1372 (83%) infants born to HIV-infected mothers initiated exclusive breastfeeding from birth. Of 1276 infants with complete feeding data, median duration of cumulative exclusive breastfeeding was 159 days (first quartile [Q1] to third quartile [Q3], 122–174 days). 14·1% (95% CI 12·0–16·4) of exclusively breastfed infants were infected with HIV-1 by age 6 weeks and 19·5% (17·0–22·4) by 6 months; risk was significantly associated with maternal CD4-cell counts below 200 cells per μL (adjusted hazard ratio [HR] 3·79; 2·35–6·12) and birthweight less than 2500 g (1·81, 1·07–3·06). Kaplan-Meier estimated risk of acquisition of infection at 6 months of age was 4·04% (2·29–5·76). Breastfed infants who also received solids were significantly more likely to acquire infection than were exclusively breastfed children (HR 10·87, 1·51–78·00, p=0·018), as were infants who at 12 weeks received both breastmilk and formula milk (1·82, 0·98–3·36, p=0·057). Cumulative 3-month mortality in exclusively breastfed infants was 6·1% (4·74–7·92) versus 15·1% (7·63–28·73) in infants given replacement feeds (HR 2·06, 1·00–4·27, p=0·051).</p> <p>Interpretation: The association between mixed breastfeeding and increased HIV transmission risk, together with evidence that exclusive breastfeeding can be successfully supported in HIV-infected women, warrant revision of the present UNICEF, WHO, and UNAIDS infant feeding guidelines.</p>
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Bland, Dr Ruth |
| Authors: | Coovadia, H.M., Rollins, N.C., Bland, R.M., Little, K., Coutsoudis, A., Bennish, M.L., and Newell, M.-L. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities |
| Journal Name: | Lancet |
| Publisher: | The Lancet Publishing Group |
| ISSN: | 0140-6736 |
| ISSN (Online): | 1474-547X |
| Published Online: | 29 March 2007 |
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