Effect of infant feeding mode and maternal nutritional supplementation on the nutrition and health of HIV positive mothers and their infants.

Abstract

Background: Breastfeeding is known to have benefits both for maternal and child health. Some

questions around the benefits and risks of breastfeeding in the presence of HIV infection still remain

unclear.

Aims: To study the effects of infant feeding mode by HIV-positive mothers, on maternal and child

health. In addition, to assess the effect of nutritional supplementation to HIV-positive lactating

mothers on nutritional and health status of mothers and their infants and on the quality of breastmilk.

Methods: The study had 2 components; a prospective study to examine the impact of infant feeding

mode on nutritional and health indices in mothers and their infants and within it a nested

randomized controlled clinical trial to study the impact of a daily 50 g soya/peanut based

supplement during breastfeeding on the above parameters. The measurements included

anthropometry; body composition indicators (using both deuterium dilution and BIA); haematology

and biochemical markers; as well as incidence rates of opportunistic infections and clinical disease

progression. Breastmilk was analysed for both macro and micronutrients. Cervical screening was

offered to all the women.

Results: AFASS criteria were fulfilled by 38.7% of the formula feeding mothers. No significant

differences between the formula feeding and breastfeeding groups in terms of haematological,

immunological and body composition changes were seen. Breastfeeding mothers had significantly

lower events with high depression scores (p=0.043). Longer duration of breastfeeding was observed

to be significantly associated with a mean increase in CD4 count (74 cells/μL) and better health

outcomes. The supplement made no significant impact on any maternal or child outcomes except for

a limited effect on mothers with low BMI, where it was significantly associated with preventing loss

of lean body mass (p=0.026). Breastfeeding infants had a significantly lower risk of diarrhoea and

hospitalisation at 3 months (p=0.006 and 0.014 respectively). Both breastfeeding and longer

duration of breastfeeding was significantly associated with better development scores and growth

parameters. Supplementation made no impact on breastmilk composition. Of the 86 mothers who

agreed for cervical screening, 27.6% had human papilloma virus infection.

Conclusions: Breastfeeding is not harmful to the mother despite the presence of HIV infection. On

the contrary we observed both breastfeeding and longer breastfeeding duration to be associated with

better maternal and child outcomes. Mothers are still choosing formula feeding inappropriately

presumably because of the availability of free formula and/or sub-optimal counseling. The new

(2010) local PMTCT guidelines based on WHO recommendations should reverse this. Food

insecurity was prevalent amongst 32% of our study population, highlighting the need to include

sustainable and empowering solutions to encounter this problem. Less sustainable solutions such as

nutritional supplementation should be targeted to the malnourished and in emergency situations.