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THREEFOLD INCREASED RISK OF DEATH AMONG HIV-1 INFECTED BREASTFEEDING MOTHERS IN LESS-DEVELOPED COUNTRIES

May 23, 2001

HIV-1 infected mothers in less-developed countries who breastfeed their infants could be more than three times more likely to die within two years of giving birth compared with mothers who use formula milk, conclude authors of a study in this week's issue of THE LANCET. The study also found that illness and death was increased among children of HIV-1 infected breastfeeding mothers .

Ruth Nduati and colleagues from the University of Nairobi, Kenya, and the University of Washington, Seattle, USA, analysed data from a previous trial (which investigated mother-to-child HIV-1 transmission from breastmilk) to examine the effect of breastfeeding on maternal death rates in the first two years after childbirth. Pregnant women attending four city council clinics in Nairobi, Kenya, were offered HIV tests. At about 32 weeks' pregnancy, 425 HIV-1 seropositive women were randomly allocated to either breastfeed or formula feed their infants. After delivery, mother-infant pairs were followed up monthly during the first year and quarterly during the second year until death, or for 2 years after delivery, or until the end of the study.

Death among mothers was higher in the breastfeeding group than in the formula group (18 compared with 6 deaths). The cumulative probability of maternal death two years after delivery was 10.5% in the breastfeeding group and 3.8% in the formula group. The attributable risk of maternal death due to breastfeeding was 69%. Infants had an eightfold increased mortality risk if their mothers died in the first two years after delivery.

In an accompanying Commentary (p 1634), Marie-Louise Newell from the Institute of Child Health, London, UK, comments: "further research may be required to confirm or refute the disturbing possibility that their [Nduati and colleagues'] study raises, and, if it is confirmed, to understand the underlying mechanism. Women with clinical progression of disease are more likely than those with stable disease to transmit the infection in utero, so breastfeeding would pose no further risk for the infant. However, if indeed breastfeeding by an HIV-infected woman with AIDS shortens her life, this finding has to be taken into account in any recommendations issued. Would nutritional and treatment support cancel out any supposed harmful effects of breastfeeding in these circumstances? The analysis here would benefit from being complemented by a creative analysis of actual feeding practice to further explore this complex issue".

Contact: Dr Ruth Nduati, Department of Paediatrics, University of Nairobi, PO 19676, Nairobi, Kenya; T) +254 2 714851; F) +254 2 712007; E) rnduati@iconnect.co.ke (or jkreiss@u.washington.edu)

Dr Marie-Louise Newell, Department of Paediatric Epidemiology & Biostatistics, Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK; T) (from Thursday 24 May) +44 (0)20 7905 2362/8699; F) +44 (0)20 7242 2723 or 7813 8145; E) m.newell@ich.ac.uk


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