Continued breastfeeding improves survival into second year of life for HIV-negative infants born to HIV-positive mothers

February 2010

An article published in Clinical Infectious Diseases in February 2010 presents an analysis of data from the Zambia Exclusive Breastfeeding Study that the authors undertook to determine an age at which weaning safely could be recommended to HIV-infected mothers of uninfected infants. During the trial, which took place from 2001 to 2004, the intervention group was advised to wean abruptly at four months while the women in the control group were advised to wean at any time they wished.

In this analysis, the investigators compared mortality rates of children weaned at 4 to 5 months, 6 to 11 months, and 12 to 18 months with mortality rates of children who continued to breastfeed beyond 18 months. According to these age groups, weaning was associated with a 2.03-fold increase, a 3.54-fold increase, and a 4.22-fold increase in mortality risk, respectively.  The elevated mortality risk associated with early weaning persisted after adjusting for maternal CD4 count during pregnancy, maternal mortality, low birth weight, number of children in the household, and reported food insecurity.

Among all women, any weaning from birth through 24 months was associated with a two-fold increased risk of mortality.  The authors emphasized that the elevated mortality risk associated with early weaning is likely to be even higher in program settings because programs cannot realistically replicate the intensity of support for safer replacement feeding that study participants received.  

Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-infected mothers