Breastfeeding patterns and mothers’health in an HIV context in Sub Saharan Africa

Introduction It has been estimated that breastfeeding is a healthier alternative than replacement feeding because of its nutritional and immunological values. If optimally implemented it has the potential to save children’s lives. Despite the HIV infection context, breastfeeding is recommended for infants born to HIV-infected women in low-income settings as the best feeding option when formula feeding is unsafe. However, both breastfeeding and HIV-infection are energy demanding. There are concerns about the effects of lactation on post-partum weight changes among HIV-infected women because low weight could increase the risk of HIV progression and worsen biological parameters, such as the CD4 cell count and HIV viral load of HIV-positive mothers. Our objectives were i) to examine the feeding practices and the determinants of exclusive/ predominant or any breastfeeding among the trial’s participants (paper 1); ii) to explore if exclusive or predominant breastfeeding is associated with a change of the body mass index (BMI) among breastfeeding HIV-1-positive women (paper 2); iii) to assess the mothers’ HIV- 1 disease progression in relation to the exclusive/predominant or any breastfeeding duration during the infant first 6 months of life and until week 50 post-partum (paper 3). Methods Our data were collected in the context of the ANRS 12174 phase 3 clinical trial (clinical trial no NCT0064026) between November 2009 and March 2013. The trial compared the efficacy of lamivudine with lopinavir/ritonavir in preventing postnatal HIV-1 transmission during lactation to infants born to HIV-1 positive mothers. Mothers infected with HIV-1 with CD4 cell count of >350 cell/μl and their uninfected offspring were followed from day 7 after birth for 50 weeks, keeping monthly records of their self-reported feeding patterns. Feeding was classified into 3 categories: 1) exclusive breastfeeding during the first 6 months, only breast-milk being given to infant for 6 months, 2) predominant breastfeeding, breast-milk with liquid-based items being given, and 3) mixed feeding, other non-breast milk or solid food being given in addition to breast milk with or without liquid-based items. The categories were merged into 2 groups: exclusive or predominant breastfeeding (EPBF) applying to infants aged 350 cells/μl. Considering the benefits of breast milk for infants, and the recurrent results from different studies that breastfeeding does not harm HIV-1-infected mothers, this study also supports the WHO 2016 guidelines on infant feeding, which indicates that mothers living with HIV should breastfeed for at least 12 months and to 24 or more, provided that the right treatment or prophylaxis for the infection is given where formula feeding is unsafe. Thus, there is a need to improve breastfeeding and complementary feeding practices of children, particularly those exposed to HIV and antiretroviral treatment, taking into account context and socio-demographic factors