title: High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission.
abstract: BACKGROUND
  Empirical data showing the clear benefits of exclusive breastfeeding (EBF) for HIV prevention are needed to encourage implementation of lactation support programs for HIV-infected women in low resource settings among whom replacement feeding is unsafe. We conducted a prospective, observational study in Lusaka, Zambia, to test the hypothesis that EBF is associated with a lower risk of postnatal HIV transmission than non-EBF.
  
  
  RESULTS
  As part of a randomized trial of early weaning, 958 HIV-infected women and their infants were recruited and all were encouraged to breastfeed exclusively to 4 months. Single-dose nevirapine was provided to prevent transmission. Regular samples were collected from infants to 24 months of age and tested by PCR. Detailed measurements of actual feeding behaviors were collected to examine, in an observational analysis, associations between feeding practices and postnatal HIV transmission. Uptake of EBF was high with 84% of women reporting only EBF cumulatively to 4 months. Post-natal HIV transmission before 4 months was significantly lower (p = 0.004) among EBF (0.040 95% CI: 0.024-0.055) than non-EBF infants (0.102 95% CI: 0.047-0.157); time-dependent Relative Hazard (RH) of transmission due to non-EBF = 3.48 (95% CI: 1.71-7.08). There were no significant differences in the severity of disease between EBF and non-EBF mothers and the association remained significant (RH = 2.68 95% CI: 1.28-5.62) after adjusting for maternal CD4 count, plasma viral load, syphilis screening results and low birth weight.
  
  
  CONCLUSIONS
  Non-EBF more than doubles the risk of early postnatal HIV transmission. Programs to support EBF should be expanded universally in low resource settings. EBF is an affordable, feasible, acceptable, safe and sustainable practice that also reduces HIV transmission providing HIV-infected women with a means to protect their children's lives.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00310726.
authors.affiliation: Gertrude H. Sergievsky Center, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America. lk24@columbia.edu
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
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: Prisca
authors.initials: P
authors.lastname: Kasonde
authors.forename: Nancy
authors.initials: N
authors.lastname: Scott
authors.forename: Mwiya
authors.initials: M
authors.lastname: Mwiya
authors.forename: Cheswa
authors.initials: C
authors.lastname: Vwalika
authors.forename: Jan
authors.initials: J
authors.lastname: Walter
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: D001942:Breast Feeding; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007223:Infant; D007225:Infant Food; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D019829:Nevirapine / Q000008:administration & dosage; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D014886:Weaning
chemical_list: D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine