Background We have completed a randomised clinical trial of breastfeeding a
nd 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 d
elivery. We report our findings from this secondary analysis.
Methods Pregnant women attending four Nairobi city council clinics were off
ered HIV tests. 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 fi
rst 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 cumulat
ive 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 relativ
e risk of death for breastfeeding mothers versus formula feeding mothers wa
s 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 c
ontrolled for (relative risk 7.9, 95% CI 3.3-18.6, p<0.001).
Interpretation Our findings suggest that breastfeeding by HIV-1 infected wo
men might result in adverse outcomes for both mother and infant.