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

TLDR

Exclusive breastfeeding is promoted to reduce postnatal HIV transmission, but evidence supporting this practice is limited. In a 2‑year trial of 14,110 mother‑newborn pairs, mothers received feeding education and were surveyed at baseline, 6 weeks, and 3 months to classify infant feeding patterns. Overall postnatal HIV transmission was 12.1%, mostly after 6 months, and early mixed or predominant breastfeeding increased transmission risk compared with exclusive breastfeeding, indicating that exclusive breastfeeding substantially reduces HIV transmission.

Abstract

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