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High uptake of exclusive breastfeeding and reduced post-natal HIV transmission: prospective results from the Zambia exclusive breastfeeding study
Presented by Louise Kuhn, United States.
Kuhn L.1, Aldrovandi G.2, Sinkala M.3, Semrau K.4, Kankasa C.5, Walter J.1, Kasonde P.5, Vwalika C.3, Mwiya M.5, Scott N.4, Thea D.4, Zambia Exclusive Breastfeeding Study (ZEBS)
1Columbia University, New York, NY, United States, 2Children's Hospital Los Angeles, Los Angeles, CA, United States, 3Zambia Ministry of Health, Lusaka, Zambia, 4Boston University, Boston, MA, United States, 5University Teaching Hospital, Lusaka, Zambia
Objective: HIV transmission through breastfeeding is a major threat to child health globally. We evaluated whether maintenance of exclusive breastfeeding (EBF) through the first 4 months of life reduced risks of postnatal HIV transmission.
Method: We conducted a prospective, epidemiologic study nested within a randomized trial evaluating the efficacy of early cessation of breastfeeding among 958 HIV-infected women and their infants in Lusaka, Zambia. All women were encouraged to breastfeed exclusively to 4 months. Detailed measurements were maintained of actual feeding behaviors and monthly samples were collected from infants to determine their HIV status.
Results: Uptake of EBF was high: >95% reported at monthly clinic visits that no other substances except breast milk had been given since the prior visit. Cumulatively through 4 months, 84% reported only EBF. The risk of HIV infection by 4 months among infants surviving HIV-free at 6 weeks was 4% (95% CI: 2.4-5.6) among those who reported EBF and 10% (95% CI: 4.7-15.7) among those who reported non-EBF (p=0.004). In a time-dependent analysis, non-EBF was associated with >3-fold risk of early postnatal HIV transmission (hazard ratio [HR] 3.5 95% CI: 1.7-6.9). The association was slightly attenuated, but remained significant (HR 2.6 95% CI: 1.3-5.3), after adjusting for other risk factors including maternal CD4 count, plasma viral load and infant birth weight. To rule out “reverse causality” i.e. infant HIV infection increasing the likelihood of non-EBF, rather than EBF increasing the likelihood of HIV infection, we examined the association between EBF and intrauterine and intrapartum infection and found no association.
Conclusions: High uptake of EBF can be achieved with a modest counseling intervention. Non-EBF more than doubles the risk of postnatal HIV transmission. Programs to encourage EBF for women in low resource settings should be supported as a matter of priority.
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