Continued breastfeeding lowers the risk of serious gastroenteritis for HIV-exposed kids

January 2010

An article in the January 2010 issue of the Journal of Acquired Immune Deficiency Syndromes analyzed the risk of serious gastroenteritis in HIV-exposed infants who participated in two different trials in the same hospital in Uganda during different time periods. Each of the trials gave advice to mothers about when to stop breastfeeding their infants based on national guidance at the time the trials took place. In the HIV Network for Prevention Trial (HIVNET 012), investigators instructed mothers to exclusively breastfeed for six months and then to stop breastfeeding as soon as possible. In the HIV hyperimmune globulin/nevirapine trial (HIVGLOB/NVP), researchers encouraged mothers to exclusively breastfeed for three to six months and then to abruptly stop breastfeeding over a two-week period. The average duration of breastfeeding in the HIVNET and HIVGLOB trials was 9.3 and 4 months, respectively. In both trials, incidence of serious gastroenteritis peaked around the average time of breastfeeding cessation. However, at every age except 9–10 months, infants in the HIVGLOB trial (earlier breastfeeding cessation) had higher rates of serious gastroenteritis through 18 months, and cumulative mortality was also higher in that group. The authors found these results to be particularly worrisome since the early cessation mothers of the HIVGLOB trial had characteristics usually assumed to be associated with successful replacement feeding, including higher education and employment rates, compared to mothers in the other trial, whose children had lower rates of serious gastroenteritis. The authors call for the development of infant feeding strategies that decrease the risk of postnatal HIV transmission yet allow HIV-infected mothers longer and safer breastfeeding for optimal nutrition and reduced risk of serious gastroenteritis.

Early Weaning of HIV-Exposed Uninfected Infants and Risk of Serious Gastroenteritis: Findings from Two Perinatal HIV Prevention Trials in Kampala, Uganda