The Breastfeeding, Antiretroviral, and Nutrition (BAN) study which was conducted in Malawi between 2004 and 2010 has revealed that breastfeeding for a longer period along with antiretroviral therapy (ART) could help reduce mother-to-child HIV transmission and improve chances of infant’s survival.
However, stopping breastfeeding before six months doesn’t protect these children from HIV infection and significantly increases their likelihood of illness, growth problems and death, found the study published in The Lancet.
The study in which 2,369 HIV-infected breastfeeding mothers and their babies were assigned to one of three 28-week regimens: maternal triple antiretroviral; daily infant nevirapine; or control group.
Initial results showed that giving antiretroviral drugs to mothers or their babies for up to six months significantly reduced the transmission of HIV to the breastfeeding infant.
However, almost a third of babies became infected after most mothers had reported weaning their babies from breastfeeding (after 28 weeks), suggesting that the chances of transmitting the virus might actually increase as a result of early weaning.
Based in part on these results, WHO now recommends antiretroviral prophylaxis for HIV-infected mothers or their babies throughout breastfeeding.
The authors, led by Denise Jamieson from the US Centers for Disease Control and Prevention, said: “Infant or maternal prophylaxis effectively reduces postnatal HIV-1 transmission and this protective effect persists until after breastfeeding is stopped.
“However, transmission does occur after mothers report that they have weaned their infants, so breastfeeding with prophylaxis for longer than 28 weeks might be advantageous.
“Infant morbidity and mortality also increased after 28 weeks, suggesting continued breastfeeding with prophylaxis given for an extended period could improve infant survival.”
In a linked comment, Louise Kuhn of Columbia University in New York and Hoosen Coovadia of Johannesburg’s University of Witwatersrand said: “BAN re-emphasises that breastfeeding is essential for infant survival and wellbeing. Early weaning is neither effective nor safe as an HIV prevention strategy.”