[pronut-hiv] Breastfeeding and maternal HIV progression (2)

["Ellen Piwoz" <epiwoz@smtp.aed.org>]

Breastfeeding and maternal HIV progression- what do we know?

There are two published studies that I am aware of -- one an analysis of data from a randomized trial on breastfeeding vs formula feeding in Nairobi, Kenya (Nduati et al) and the other an analysis of data from a vitamin A trial in Durban SA.  I also understand that preliminary results from an Africa-wide meta-analysis have been presented at a recent international conference - in July (Paris).

Briefly:

1) The Nairobi study observed that BF HIV+ mothers were 2.9 times more likely to die than non-BF mothers.  However, about half of the 24 mothers who died in that study had CD4 < 200 at baseline. A low CD 4 count was the most important predictor of maternal death, with a RR of 14.7 compared with women enrolling with CD4 > 500.  There was a commentary written on this study when it appeared in Lancet in 2001.

2) The Durban study found no increased risk of death associated with BF by HIV+ mothers; however there were few maternal deaths overall in that study (n=5), reported by Coutsoudis et al, 2001 (AIDS).

3) I did not hear the meta-analysis presentation in Paris, but slides were available on the web and there is an abstract for it (Newell et al).  If I understand correctly, the analysis included a total of 162 deaths among 4237 HIV+ women.  Mortality by 12 months post-delivery among breastfeeding mothers was significantly lower than among non-breastfeeding mothers.  Analysis is ongoing and looking at things like the duration of breastfeeding and risk of maternal death. Low CD4 was associated with higher risk of maternal death.

The effect of breastfeeding on maternal HIV disease progression and nutritional status is being studied.  I know of one study that is planned to look at the impact of nutrition supplementation in HIV+ breastfeeding mothers.  

In my opinion, keeping HIV+ mothers healthy is probably one of the most important things we can do for preventing orphanhood, improving the survival of children born to HIV+ mothers, and preventing transmission by breastfeeding if that is the chosen practice.

Ellen


>>> sternworks@att.net 10/23/03 04:47PM >>>

Breastfeeding and Maternal HIV disease progression- what do we know?

I have tried to ask this question before, but suspect my messages have
not gone through.

Are there data on breastfeeding and maternal HIV progression, maternal
morbidity, and maternal survival?

Thanks.

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