BACKGROUND: We have completed a randomised clinical trial of breastfeeding and formula feeding to identify the frequency of breastmilk transmission of HIV-1 to infants. However, we also analysed data from this trial to examine the effect of breastfeeding on maternal death rates during 2 years after delivery. We report our findings from this secondary analysis. METHODS:Pregnant women attending four Nairobi city council clinics were offered HIVtests. At about 32 weeks' gestation, 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 2 years after delivery, or end of study. FINDINGS:Mortality among mothers was higher in the breastfeeding group than in the formula group (18 vs 6 deaths, log rank test, p=0.009). The cumulative probability of maternal death at 24 months after delivery was 10.5% in the breastfeeding group and 3.8% in the formula group (p=0.02). The relative risk of death for breastfeeding mothers versus formula feeding mothers was 3.2 (95% CI 1.3-8.1, p=0.01). The attributable risk of maternal death due to breastfeeding was 69%. There was an association between maternal death and subsequent infant death, even after infant HIV-1 infection status was controlled for (relative risk 7.9, 95% CI 3.3-18.6, p<0.001). INTERPRETATION: Our findings suggest that breastfeeding by HIV-1 infected women might result in adverse outcomes for both mother and infant.
RCT Entities:
BACKGROUND: We have completed a randomised clinical trial of breastfeeding and formula feeding to identify the frequency of breastmilk transmission of HIV-1 to infants. However, we also analysed data from this trial to examine the effect of breastfeeding on maternal death rates during 2 years after delivery. We report our findings from this secondary analysis. METHODS: Pregnant women attending four Nairobi city council clinics were offered HIVtests. At about 32 weeks' gestation, 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 2 years after delivery, or end of study. FINDINGS: Mortality among mothers was higher in the breastfeeding group than in the formula group (18 vs 6 deaths, log rank test, p=0.009). The cumulative probability of maternal death at 24 months after delivery was 10.5% in the breastfeeding group and 3.8% in the formula group (p=0.02). The relative risk of death for breastfeeding mothers versus formula feeding mothers was 3.2 (95% CI 1.3-8.1, p=0.01). The attributable risk of maternal death due to breastfeeding was 69%. There was an association between maternal death and subsequent infantdeath, even after infantHIV-1 infection status was controlled for (relative risk 7.9, 95% CI 3.3-18.6, p<0.001). INTERPRETATION: Our findings suggest that breastfeeding by HIV-1 infectedwomen might result in adverse outcomes for both mother and infant.
Authors: R Nduati; G John; D Mbori-Ngacha; B Richardson; J Overbaugh; A Mwatha; J Ndinya-Achola; J Bwayo; F E Onyango; J Hughes; J Kreiss Journal: JAMA Date: 2000-03-01 Impact factor: 56.272
Authors: J C Melchior; G Raguin; A Boulier; E Bouvet; D Rigaud; S Matheron; E Casalino; J L Vilde; F Vachon; J P Coulaud Journal: Am J Clin Nutr Date: 1993-05 Impact factor: 7.045
Authors: E M Connor; R S Sperling; R Gelber; P Kiselev; G Scott; M J O'Sullivan; R VanDyke; M Bey; W Shearer; R L Jacobson Journal: N Engl J Med Date: 1994-11-03 Impact factor: 91.245
Authors: C P Lindan; S Allen; A Serufilira; A R Lifson; P Van de Perre; A Chen-Rundle; J Batungwanayo; F Nsengumuremyi; J Bogaerts; S Hulley Journal: Ann Intern Med Date: 1992-02-15 Impact factor: 25.391
Authors: Valerie L Flax; Margaret E Bentley; Charles S Chasela; Dumbani Kayira; Michael G Hudgens; Rodney J Knight; Alice Soko; Denise J Jamieson; Charles M van der Horst; Linda S Adair Journal: J Nutr Date: 2012-05-30 Impact factor: 4.798
Authors: Chelsea B Polis; Maria J Wawer; Noah Kiwanuka; Oliver Laeyendecker; Joseph Kagaayi; Tom Lutalo; Fred Nalugoda; Godfrey Kigozi; David Serwadda; Ronald H Gray Journal: AIDS Date: 2010-07-31 Impact factor: 4.177
Authors: Charles van der Horst; Charles Chasela; Yusuf Ahmed; Irving Hoffman; Mina Hosseinipour; Rodney Knight; Susan Fiscus; Michael Hudgens; Peter Kazembe; Margaret Bentley; Linda Adair; Ellen Piwoz; Francis Martinson; Ann Duerr; Athena Kourtis; A Edde Loeliger; Beth Tohill; Sascha Ellington; Denise Jamieson Journal: Contemp Clin Trials Date: 2008-09-07 Impact factor: 2.226
Authors: Amanda H Corbett; Dumbani Kayira; Nicole R White; Nicole L Davis; Athena P Kourtis; Charles Chasela; Francis Martinson; Grace Phiri; Bonaface Musisi; Deborah Kamwendo; Michael G Hudgens; Mina C Hosseinipour; Julie Ae Nelson; Sascha R Ellington; Denise J Jamieson; Charles van der Horst; Angela Kashuba Journal: Antivir Ther Date: 2014-01-24
Authors: Anna Lartey; Grace S Marquis; Robert Mazur; Rafael Perez-Escamilla; Lucy Brakohiapa; William Ampofo; Daniel Sellen; Seth Adu-Afarwuah Journal: Matern Child Nutr Date: 2012-08-20 Impact factor: 3.092