Breastfeeding Protects Babies Born To HIV-Infected Mothers

by Amy Spangler
February 03, 2010

Breastfeeding keeps babies healthy, but breastfeeding can also make babies sick. The United States Agency for International Development (USAID) in 2008 estimated that 430,000 children under the age of 15 were newly infected with the human immunodeficiency virus (HIV). Most infections were transmitted from mother-to-child during pregnancy, labor, birth, or while breastfeeding. It is estimated that breastfeeding may account for one-third to one-half of all cases of mother-to-child-transmission.

The Centers for Disease Control and Prevention (CDC) recommends that HIV-infected women in the United States not breastfeed. However, in countries where safe alternatives to human milk are scarce and the risk of infant death from illnesses other than AIDS is high, health authorities must balance breastfeeding’s benefits and risks.

Because the risk of mother-to-child transmission of HIV is relatively constant throughout the period of breastfeeding, and the risk of death in non-breastfed infants compared to breastfed infants declines with age, one strategy for balancing breastfeeding’s competing risks is to encourage mothers to breastfeed exclusively for four months then abruptly wean. In an effort to test this theory, researchers followed 749 children not infected with HIV but born to HIV-positive mothers for 24 months. The children were randomly assigned to two groups. One-half of the children were breastfed exclusively for four months and then abruptly weaned. The other half continued to breastfeed.

Researchers found that the earlier a child is weaned, the greater that child’s risk for dying before the age of 2. The mortality rate for children weaned at 4–5 months, 6–11 months, and 12–18 months was 2, 3, and 4 times greater than children breastfed longer than 18 months. Diarrhea was the leading cause of death, accounting for nearly 62 percent of the deaths in children 6–24 months of age.

The only reason to encourage early weaning is to reduce the risk for mother-to-child transmission of HIV. However, nothing is gained if the child remains free of HIV but dies from a disease longer breastfeeding could have prevented.