Long-term results of the Breastfeeding, Antiretrovirals, and Nutrition (BAN) randomized trial reveals that breastfeeding for a longer period along (6+ months) with antiretroviral therapy (ART) could help reduce mother-to-child HIV transmission as well as improve chances of infant’s survival.

Children are not protected from HIV infection, however, if breastfeeding is stopped before 6 months, the risk of growth problems, illness and mortality is increased.

In an associated comment, Louise Kuhn from Columbia University, New York, USA, and Hoosen Coovadia from the University of Witwatersrand, Johannesburg, South Africa, write:

“BAN re-emphasizes that breastfeeding is essential for infant survival and wellbeing. Early weaning is neither effective nor safe as an HIV prevention strategy.”

The trial, conducted in Malawi between March 2004 and January 2010, enrolled 2,369 HIV-positive mothers and their babies. Study participants were assigned to one of three groups:

  • Maternal-antiretroviral
  • Infant-prophylaxis
  • Control group

Initial results from the trial demonstrated that HIV transmission was significantly reduced by giving antiretroviral drugs to mothers or their babies for up to 6 months. As a result, the World Health Organization (WHO) currently recommends that HIV-infected mothers or their babies receive antiretroviral prophylaxis throughout breastfeeding.

In this report, Denise Jamieson from the US Centers for Disease Control and Prevention, and her team reveal the long-term outcomes of the trial, specifically focusing on the safety and effects of weaning and stopping of antiretroviral prophylaxis at 28 weeks after birth.

The researchers found that at 48 weeks, the control group was at a significantly higher risk of HIV transmission (7%) than the infant-prophylaxis group (4%) or the maternal-antiretroviral group (4%).

In addition, the team found that early weaning, i.e. after 28 weeks, may in fact increase the chances of HIV transmission, after almost 30% of babies became infected.

Babies weaned early were also considerably more likely to develop malaria, tuberculosis, diarrhea, have growth problems or die. During the 29-48 week follow-up period, the rate of serious adverse events in babies was significantly higher than the 28-week intervention phase. During the 48-week follow-up, 1 mother in the maternal-antiretroviral group died vs. 8 in the control group, indicating that ART might contribute to improved maternal survival.

The researchers conclude:

“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, suggesting that continued breastfeeding with prophylaxis given for an extended period could improve infant survival.”

Written By Grace Rattue