Rethinking Breast-Feeding Among HIV-Infected Mothers

Breast-feeding accounts for up to 40% of mother-to-child HIV transmissions. Thus, HIV-infected women in developed countries are encouraged to formula-feed their infants; among breast-feeding populations in developing countries, women are advised to stop nursing at 6 months. Some studies have found that adding formula or solid food to the diet of breast-fed infants increases the risk for HIV transmission, compared with exclusive breast-feeding or formula-feeding.

These investigators prospectively followed 1372 HIV-positive, South African women and their children for 6 months. All women received single-dose nevirapine to take during labor and were counseled about infant-feeding options. Feeding patterns were carefully assessed through weekly home visits. Most women (83%) initiated exclusive breast-feeding; 40% continued at 6 months. At 3 months, the cumulative mortality was significantly higher among infants given formula (with or without solid food, but no breast milk) than among infants who were exclusively breast-fed (15% vs. 6%). The risk for HIV infection was higher among infants who, in addition to being breast-fed, received formula at 14 weeks (hazard ratio, 1.8; P=0.057) or solids at any time (HR, 10.9; P=0.018), compared with infants who were exclusively breast-fed.