HIV transmission risk lowered by continual breastfeeding

Study showing increased risk of HIV transmission from HIV+ mother to infant with interrupted breastfeeding relative to continual breastfeeding.  Wonder why this study was done in Zambia and why was there ‘abrupt weaning. Non exclusive breastfeeding implies some additional populational issues in play.
Some 
conclusions: A) if an HIV+ mother chooses to breastfeed her newborn, forced removal or weaning increases HIV transmission to infant risk if the mother resumes breastfeeding, B)state-forced removal would seem to be a risky option and not advisable C) still seem to consider breast milk as ‘dangerous’.

It makes me wonder what is being measured in the final analyses; yet another problem with the models associated with predicting HIV spread.

HIV-1 Concentrations in Human Breast Milk Before and After Weaning
Louise Kuhn1 et al.
Link:
 
http://stm.sciencemag.org/content/5/181/181ra51

Abstract
Concentrations of HIV-1 RNA and DNA in mucosal compartments influence the risk of sexual transmission and mother-to-child transmission of HIV-1. Breast milk production is physiologically regulated such that supply is a function of infant demand, but whether demand also influences HIV-1 dynamics in breast milk is unknown. We tested whether minor and major changes in feeding frequency influence breast milk viral concentrations in 958 HIV-1–infected women and their infants followed, for 24 months during a trial in Lusaka, Zambia. Women were randomized to wean abruptly at 4 months or to continue breast-feeding for a duration of their own choosing. Two weeks after breast-feeding cessation (4.5 months), HIV-1 concentrations in breast milk were substantially higher (median RNA, 2708 copies/ml; DNA, 14 copies/ml) than if breast-feeding continued (median RNA, <50 copies/ml; DNA, <1 copy/ml; P < 0.0001).
Among those continuing breast-feeding, HIV-1 concentrations in milk were higher if breast-feeding was nonexclusive (median RNA, 293 copies/ml; DNA, 2 copies/ml; P = 0.0006). Elevated milk viral concentrations after stopping breast-feeding explained higher than expected rates of late postnatal HIV transmission in those who weaned early.  Changes in the frequency of breast-feeding peri-weaning and with nonexclusive breast-feeding influenced milk viral concentrations.
This may explain the reduced risk of HIV-1 transmission associated with exclusive breast-feeding and why early weaning does not achieve the magnitude of HIV prevention predicted by models. Our results support continuation of maternal antiretroviral drug interventions over the full duration of time when any breast milk exposures may occur after planned weaning.
Copyright © 2013, American Association for the Advancement of Science

 

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