Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial

Lancet. 2001 May 26;357(9269):1651-5. doi: 10.1016/S0140-6736(00)04820-0.


Background: We have completed a randomised clinical trial of breastfeeding and formula feeding to identify the frequency of breastmilk transmission of HIV-1 to infants. However, we also analysed data from this trial to examine the effect of breastfeeding on maternal death rates during 2 years after delivery. We report our findings from this secondary analysis.

Methods: Pregnant women attending four Nairobi city council clinics were offered HIVtests. At about 32 weeks' gestation, 425 HIV-1 seropositive women were randomly allocated to either breastfeed or formula feed their infants. After delivery, mother-infant pairs were followed up monthly during the first year and quarterly during the second year until death, or 2 years after delivery, or end of study.

Findings: Mortality among mothers was higher in the breastfeeding group than in the formula group (18 vs 6 deaths, log rank test, p=0.009). The cumulative probability of maternal death at 24 months after delivery was 10.5% in the breastfeeding group and 3.8% in the formula group (p=0.02). The relative risk of death for breastfeeding mothers versus formula feeding mothers was 3.2 (95% CI 1.3-8.1, p=0.01). The attributable risk of maternal death due to breastfeeding was 69%. There was an association between maternal death and subsequent infant death, even after infant HIV-1 infection status was controlled for (relative risk 7.9, 95% CI 3.3-18.6, p<0.001).

Interpretation: Our findings suggest that breastfeeding by HIV-1 infected women might result in adverse outcomes for both mother and infant.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Bottle Feeding
  • Breast Feeding*
  • Cause of Death
  • Female
  • HIV Infections / mortality*
  • HIV Infections / transmission
  • HIV-1*
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical
  • Kenya
  • Milk, Human / virology
  • Puerperal Infection / mortality*
  • Puerperal Infection / transmission
  • Survival Analysis