Posted by: Indonesian Children | June 14, 2009

ABSTRACT WATCH : Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study


Prof Hoosen M Coovadia MD a, Prof Nigel C Rollins MD b c , Ruth M Bland MB c, Kirsty Little MSc d, Prof Anna Coutsoudis PhD b, Michael L Bennish MD e, Prof Marie-Louise Newell

The Lancet, Volume 369, Issue 9567, Pages 1107 – 1116, 31 March 2007


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.


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.

Findings1132 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).


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.


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  1. Dear Dr.Widodo,
    Terimakasih atas e-mail yang banyak dan bagus-bagus. Kok Anda rajin sekali sh?
    Saya pernah dapat dari kursus breast-feeding online, bahwa morbiditas & mortalitas bayi yang dilahirkan oleh ibu-ibu dengan HIV; bila tinggal di area yang kumuh, tidak tersedia air bersih atau sarana untuk memasak air dengan baik, akan lebih buruk bila tidak diberi ASi secara eksklusif. Sayang saya lupa referensinya, apa Dr.Widodo tahu?

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