Early Weaning in HIV Positive Feeding?

Breastfeeding and HIV transmission from mother to child

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) Breastfeeding may be seen as optional in the Western world. But in other places, it may be necessary for the survival of the child, even if the mother has HIV.

The concentrations of HIV in breast milk can affect the likelihood of passing the virus to the baby.

A new study found that weaning infants early and other changes to breastfeeding frequency affected the HIV concentrations in breast milk.

"Discuss breastfeeding with your OB/GYN."

Louise Kuhn, MPH, of the Mailman School of Public Health at Columbia University in New York, led the study, which took place in Lusaka, Zambia. Dr. Kuhn and team followed 958 HIV-1 positive women and their infants for 24 months.

The women were advised to breastfeed for at least four months. At this point, half were asked to wean the children from breastfeeding abruptly and half were advised to breastfeed as long as they chose.

Two weeks after the four-month mark was reached (4.5 months into the study), the mothers' breast milk was tested for concentration of HIV.

Of the women who had weaned early, the average concentration of HIV-1 were much higher than the levels of the women who continued to breastfeed.

The authors reported that at the 4.5-month test, 77.3 percent of the women who had weaned early had HIV concentrations higher than the HIV detection threshold, while the same was true for only 39.5 percent of the women still breastfeeding. These differences were not present two weeks earlier, before the mothers’ breastfeeding behavior was modified.

The study also included some participants that continued to breastfeed, but also were giving other foods (either liquids or solids) to their child.

These women’s breast milk concentrations of HIV-1 were lower than the mothers who completely weaned early but higher than those who were exclusively breastfeeding.

“We demonstrate that major changes in the frequency of infant feeding that occur around the time of weaning play a critical role in determining concentrations of HIV-1 in breast milk,” the authors wrote.

“This may explain the reduced risk of HIV-1 transmission associated with exclusive breastfeeding and why early weaning does not achieve the magnitude of HIV prevention predicted by models,” they wrote.

The authors also noted, “The study was done before antiretroviral therapy even for women with advanced disease became available in the public sector in Zambia.”

Further research is needed to explore HIV breast milk concentrations for women who are on antiretroviral medications. 

The study was published on April 17 by Science Translational Medicine. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
April 23, 2013
Last Updated:
November 25, 2013