Nutrition News for Africa
Abstract - March 15, 2007
An article entitled “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”
was published by Otieno al, in The Journal of Infectious Diseases
2007; 195:220–9
Background: In a randomized clinical trial
in Kenya, HIV-1–infected women randomized to breast-feed
had a significantly increased risk of maternal mortality,
compared with women randomized to formula feed. However, 4
subsequent studies conducted in Tanzania, Zambia, South Africa,
and Zimbabwe did not find significant differences in mortality
risks attributable to breast-feeding among HIV-1–infected
mothers. The purpose of this study was to prospectively compare
immunological and viral markers of HIV-1 disease progression,
as well as the risk of mortality between breast-feeding and
formula-feeding HIV-1–infected women.
Methods: A prospective cohort study was
conducted in Nairobi, Kenya, from October 2000 to June 2005.
HIV-1–seropositive women were enrolled during pregnancy
and received short-course zidovudine, CD4 cell count–based
provision of cotrimoxazole prophylaxis, multivitamin supplementation
for 6 months postpartum, and referral for provision of HAART
when severely immuno-suppressed. Women were counseled on safe
infant-feeding options and were given at least 2 weeks to
decide on how they planned to feed their infants. 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 and Discussion: Of 319 women enrolled,
312 (98%) were followed to delivery, and 296 (93%) had information
on infant feeding and CD4 cell counts. Ninety-eight women
(33%) elected to formula feed their infants, and 198 (67%)
elected to breast-feed them.
There were significant differences in CD4 cell count decline
and BMI between breast-feeding and non–breast-feeding
women but no differences in HIV-1 RNA levels or mortality
over the 2-year postpartum period. The mothers in this study
had a significant decrease in CD4 cell count between months
1 and 24 postpartum. CD4 cell count decline was highest among
the current breast-feeding women in the present study, and
this decrease was significantly higher than that for the never
breastfeeding women. Breast-feeding had an effect on BMI but
was not associated with postpartum body cell mass changes
in women. For the current World Health Organization recommended
6 months duration of exclusive breast-feeding for HIV-1–infected
women data from this study suggests that breast-feeding would
have a minimal adverse effect on CD4 cell count. The women
who chose to formula feed had more education, were more likely
to have access to flush toilets, and were more likely to report
a history of HIV-1–related illness.
Conclusion: In summary, the authors suggest
that, with good maternal follow-up—including monitoring
for immuno-suppression and management of immuno-suppressed
women via both the use of cotrimoxazole prophylaxis and referral
to HAART programs—the potential effects of breast-feeding
on CD4 cell count and nutrition are attenuated and the risks
of increases in HIV-1 RNA level or mortality are minimized.
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