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Understanding the risk of human immunodeficiency virus (HIV) transmission through breastfeeding is essential for advising HIV-infected mothers and formulating public health policy recommendations. The papers objective is to measure the frequency, timing, and risk factors of HIV transmission through breast milk. Prospective cohort study conducted between 1994 and 1997, with follow-up of infants through 24 months of age. Postnatal clinic of tertiary care hospital, Blantyre, Malawi. A total of 672 infants (HIV-negative at birth) born to HIV-infected women who had not reserved antiretroviral drugs during or after pregnancy. Measure Incidence of HIV in breastfed infants by age and maternal and infant risk factors for HP/ transmission, using proportional hazard models to derive risk ratios (RRs) and 95% confidence intervals (CIs). Forty-seven children became HIV-infected while breastfeeding but none after breastfeeding had stopped. The cumulative infection rate while breastfeeding, from month 1 to the end of months 5,11,17, and 23, was 3.5%, 7.0%, 8.9%, and 103%, respectively. Incidence per month was 0.7% during age 1 to 5 months. 0.6% dung age 6 to 11 months, and 0 3% during age 12 to 17 months ( P = .01 for trend). The only factors significantly associated with low risk of postnatal HIV transmission in a multivariate model were high maternal panty (RR. 0.23; 95% CI. 0.09-0.56) and older maternal age (RR 0.44; 95% CI. 0.23-0.84). Our data suggest that the risk of HIV infection is highest in the early months of breastfeeding, which should be considered in formulating breastfeeding policy recommendations. |
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