106 Safer Breastfeeding for Babies Born to HIV-Positive Mothers: Part of the Answer to a Dilemma Jean Humphrey*1,3,4, E Piwoz2,4, P Iliff3,4, N Tavengwa4, and E Marinda4 1Bloomberg Sch of Publ Hlth, John Hopkins Univ, Baltimore, MD, USA; 2The SARA Project, Academy for Ed Devt, Washington, DC, USA; 3The Univ of Zimbabwe Coll of Hlth Sci, Harare; and 4ZVITAMBO Project, Harare, Zimbabwe

Breastfeeding transmission of HIV creates a poignant dilemma:  breastfeeding both averts ~6 million infant deaths each year and results in ~280,000 infant HIV infections.   When replacement feeding is not acceptable, feasible, affordable, sustainable or safe for HIV-positive mothers, exclusive breastfeeding (EBF: only breast milk) during the first months of life is recommended. In one study, postnatal transmission (PNT) was lower among infants who were EBF compared to mixed breastfed (MBF: other foods + breast milk) during the first 3 mo of life.

ZVITAMBO, a RCT of postpartum vitamin A supplementation among 14,110 mother/ infant pairs, investigated the role of infant feeding practices on PNT.   Pairs were enrolled 9/1997 – 1/2000 and followed at 6 wks and then 3-monthly up to 24 mo.  Women were tested for HIV and encouraged, but not required, to learn their results.  Following publication of new guidelines on infant feeding and HIV by UN agencies in June 1998, a program to inform and counsel mothers about this issue was developed and implemented within the trial by 9/1999.  It promoted 4 “safer breastfeeding” practices for HIV-positive mothers who chose to breastfeed, HIV-negative mothers, and mothers who chose not to learn their status (EBF to 6 months, optimal breastfeeding techniques, prompt treatment of breast problems, and safe sex).  Known HIV-positive women were counseled to stop breastfeeding early. 

4495 mothers were HIV-positive; 2060 of their infants were PCR-negative at 6 wk and provided complete feeding data to 3 mo.  All initiated breastfeeding; 156 (7.6%), 490 (23.8%), and 1414 (68.6%) infants EBF, predominantly (PBF) (breast milk + non-milk liquids), or MBF, respectively, during the first 3 months of life.    

Compared with EBF, MBF was associated with a 4.03 (95% CI: 0.98, 16.61), 3.79 (95% CI: 1.40-10.29), and 2.60 (95% CI: 1.21-5.55) greater risk of PNT at 6, 12, and 18 months, respectively. PBF was associated with a 1.6 – 2.6 greater (NS) risk.  Mothers exposed to the program were 70% more likely to learn their HIV status early (< 3 mo) and 8.4 times more likely to EBF.  Each additional program contact was associated with a significant reduction in PNT.