title: Prolonged breast-feeding and mortality up to two years post-partum among HIV-positive women in Zambia.
abstract: BACKGROUND
  A previously reported association between prolonged lactation and maternal mortality has generated concern that breast-feeding may be detrimental for HIV-positive women.
  
  
  METHODS
  As part of a trial conducted in Lusaka, Zambia, 653 HIV-positive women were randomly assigned either to a counseling program that encouraged abrupt cessation of breast-feeding at 4 months (group A) or to a program that encouraged prolonged breast-feeding for the duration of the woman's own informed choice (group B). We examined whether mortality up to 2 years post-partum increased with breast-feeding for a longer duration.
  
  
  RESULTS
  There was no difference in mortality 12 months after delivery between 326 HIV-positive women randomly assigned to short breast-feeding [group A: 4.93%; 95% confidence interval (CI), 2.42-7.46] versus 327 women assigned to long breast-feeding (group B: 4.89%; 95% CI, 2.38-7.40). Analysis based on actual practice, rather than random assignment, also demonstrated no increased mortality due to breast-feeding.
  
  
  CONCLUSIONS
  Although HIV-related mortality was high in this cohort of untreated HIV-positive women, prolonged lactation was not associated with increased mortality.
authors.affiliation: Gertrude H. Sergievsky Center, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA. lk24@columbia.edu
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
authors.forename: Prisca
authors.initials: P
authors.lastname: Kasonde
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.forename: Katherine
authors.initials: K
authors.lastname: Semrau
authors.forename: Cheswa
authors.initials: C
authors.lastname: Vwalika
authors.forename: Wei-Yann
authors.initials: WY
authors.lastname: Tsai
authors.forename: Grace M
authors.initials: GM
authors.lastname: Aldrovandi
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
mesh_terms: D000328:Adult; D000367:Age Factors; D001942:Breast Feeding / Q000009:adverse effects*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D014886:Weaning; D015024:Zambia / Q000453:epidemiology