Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial.
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.


RESULTS
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).


CONCLUSIONS
Our findings suggest that breastfeeding by HIV-1 infected women might result in adverse outcomes for both mother and infant.
Nduati
R
R
Departments of Paediatrics and Medical Microbiology, PO Box 19676, University of Nairobi, Nairobi, Kenya. nduati@iconnect.co.ke
Richardson
B A
BA
John
G
G
Mbori-Ngacha
D
D
Mwatha
A
A
Ndinya-Achola
J
J
Bwayo
J
J
Onyango
F E
FE
Kreiss
J
J
D000328:Adult; D001903:Bottle Feeding; D001942:Breast Feeding; D002423:Cause of Death; D005260:Female; D015658:HIV Infections / Q000401:mortality* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007630:Kenya; D008895:Milk, Human / Q000821:virology; D011645:Puerperal Infection / Q000401:mortality* / Q000635:transmission; D016019:Survival Analysis