AEGiS-13IAC: Impact of breastfeeding on meternal mortality among HIV-1 infected women: Results of a randomized clinical trail.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Impact of breastfeeding on meternal mortality among HIV-1 infected women: Results of a randomized clinical trail.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrC495)

Nduati R, Richardson B, John G, Mbori-Ngacha D, Overbaugh J, Mwatha T, Ndinya-Achola J, Bwayo J, Kreiss J
R. Nduati, University of Nairobi, Box 19676, Department of Medical Microbiology Annexe, University of Nairobi, Nairobi, Kenya, Kenya, Tel.: 254-2-722710, Fax: 254-2-722762, E-mail: rnduati@iconnect.co.ke

BACKGROUND: We analyzed data from a randomized clinical trial of breastfeeding and formula feeding to determine the impact of breast feeding on maternal mortality among HIVu1 infected women.

METHODS: Pregnant women attending 4 Nairobi city council clinics were offered HIV testing. At é ºim32 weeks of gestation, HIV-1 seropositive women were randomized to formula feed or breastfeed their infant. Blood was obtained for T-cell subset estimation and HIV-1 RNA testing. After delivery, mother/infant pairs were followed monthly during the first year and quarterly during the second year until death or 2 years post delivery.

RESULTS: Four hundred and twenty-five women were randomized, 212 into the breastfeeding arm and 213 into the formula arm. Maternal mortality was significantly higher in the breastfeeding arm than in the formula arm. Specifically, 18 women in the breastfeeding arm and six in the formula arm died during follow-up. The cumulative probability of maternal death at 24 months postpartum was 10.5% in the breastfeeding arm and 3.8% in the formula arm (p = 0.02). Twenty-two percent of the overall excess mortality had taken place by 6 weeks, 55% by 6 months, 72% by 1 year, and 100% by 18 months. Overall, there was a three-fold increased risk of dying among women in the breastfeeding arm (RR 3.2, 95% CI 1.3, 8.1). Sixty-nine percent of the deaths in the breastfeeding arm were attributable to breastfeeding.

CONCLUSIONS: Breastfeeding was associated with a significantly increased risk of maternal mortality. The results of this randomized clinical trial suggest that breastfeeding by HIV infected women may result in adverse consequences for mother as well as infant.

Keywords: AEGIS, HIV-1, Breast Feeding, HIV Infections, Dietary Supplements, Mothers, Maternal Mortality, Human, Female, Infant, Pregnancy, mortality
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WeOrC495