HIV-1 disease progression in breast-feeding and formula-feeding mothers: a prospective 2-year comparison of T cell subsets, HIV-1 RNA levels, and mortality.
BACKGROUND
There is conflicting evidence regarding the effects of breast-feeding on maternal mortality from human immunodeficiency virus type 1 (HIV-1) infection, and little is known about the effects of breast-feeding on markers of HIV-1 disease progression.


METHODS
HIV-1-seropositive women were enrolled during pregnancy and received short-course zidovudine. HIV-1 RNA levels and CD4 cell counts were determined at baseline and at months 1, 3, 6, 12, 18, and 24 postpartum and were compared between breast-feeding and formula-feeding mothers.


RESULTS
Of 296 women, 98 formula fed and 198 breast-fed. At baseline, formula-feeding women had a higher education level and prevalence of HIV-1-related illness than did breast-feeding women; however, the groups did not differ with respect to CD4 cell counts and HIV-1 RNA levels. Between months 1 and 24 postpartum, CD4 cell counts decreased 3.9 cells/ microL/month (P<.001), HIV-1 RNA levels increased 0.005 log(10) copies/mL/month (P=.03), and body mass index (BMI) decreased 0.03 kg/m(2)/month (P<.001). The rate of CD4 cell count decline was higher in breast-feeding mothers (7.2 cells/ microL/month) than in mothers who never breast-fed (4.0 cells/ microL/month) (P=.01). BMI decreased more rapidly in breast-feeding women (P=.04), whereas HIV-1 RNA levels and mortality did not differ significantly between breast-feeding and formula-feeding women.


CONCLUSIONS
Breast-feeding was associated with significant decreases in CD4 cell counts and BMI. HIV-1 RNA levels and mortality were not increased, suggesting a limited adverse impact of breast-feeding in mothers receiving extended care for HIV-1 infection.
Otieno
Phelgona A
PA
Centre for Clinical Research, Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya.
Brown
Elizabeth R
ER
Mbori-Ngacha
Dorothy A
DA
Nduati
Ruth W
RW
Farquhar
Carey
C
Obimbo
Elizabeth M
EM
Bosire
Rose K
RK
Emery
Sandy
S
Overbaugh
Julie
J
Richardson
Barbra A
BA
John-Stewart
Grace C
GC
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015992:Body Mass Index; D001903:Bottle Feeding; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000401:mortality* / Q000821:virology; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D041943:Infant Formula; D008428:Maternal Mortality; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology; D012367:RNA, Viral / Q000097:blood*; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral