Breastfeeding and Maternal HIV-1 Disease Progression and Mortality

Gilda Sedgh, Harvard University
Donna Spiegelman, Harvard University
Gernard Msamanga, Muhimbili University College of Health Sciences
Wafaie W. Fawzi, Harvard University

Background: Although many investigators have studied the association of breastfeeding by HIV-infected women with infant health and mortality, researchers have only recently begun to question whether breastfeeding affects disease progression and mortality in HIV-infected mothers. The two published studies on this topic yielded conflicting results, leaving the question unresolved. Objective: To examine the association between breastfeeding and disease progression among HIV-infected women in Dar es Salaam, Tanzania. Methods: Cohort study design with Cox proportional hazards models. Findings: Neither breastfeeding status nor the duration of exclusive or partial breastfeeding by infected women was associated with maternal death or development of a low CD4 cell count, anemia or excessive weight loss, in multivariate analyses. These associations remained insignificant when women with relatively low and high baseline CD4 cell counts were analyzed separately. Interpretation: There is insufficient evidence to support the hypothesis that breastfeeding is detrimental to the health of HIV-infected women.