My email program is acting up so I can't find the original
lactnet request however, the person looking for info on
disease progression among breastfed and non-breastfed
children might find the following abstract helpful.
Karleen Gribble
Australia
Breastfeeding and disease progression among perinatally
HIV-infected children in Los Angeles County (LAC).
Conf Retroviruses Opportunistic Infect 1997 Jan 22-26;
4th:197 (abstract no. 720)
Frederick T, Mascola L, Tucker D, Jackson J, George J;
County of Los Angeles Department of Health Services, Los
Angeles, CA.
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Background: Because breastmilk is an established means of
HIV transmission, HIV+ women in the US are counselled not to
breastfeed. Women unaware of their HIV status, however, may
unknowingly breastfeed. The effect of breastfeeding on HIV
disease progression in perinatally HIV-infected infants was
examined.
Methods: An active surveillance study of all HIV-infected
children in LAC began in 1988. Baseline data, including
breastfed status (yes/no) and maternal injection drug use
(IDU), and 6 mo. follow-up data are routinely collected on
standardized forms.
Results: As of 6/96, 197 HIV-infected children, evaluated
for HIV after 1 month of age, were reported. Breastfeeding
status was known for 138 (70%). The 59 children with unknown
status were more likely Black (42% vs. 32% for known status,
p is less than .05) and to have died (56% vs. 34%, p is less
than .01). 43% of children with known status (60/138) were
breastfed (BF). At last follow-up, non-breastfed (NBF)
children compared to BF were more likely to have AIDS (58%
vs. 48%), and PCP (31% vs. 18%) although statistical
significance at p is less than .05 was not reached.
Kaplan-Meier estimate of median time to AIDS was 42 mos. for
NBF and 74 mos. for BF (gehan test, p is less than .10).
Median time to death was 95 mos. for NBF and still undefined
for BF with 75% survival probability at 55 months vs. 29
mos. for NBF. Recurrent diarrhea was more frequent in NBF
vs. BF (16% vs. 3%, p is less than .05). Recurrent diarrhea
was associated with time to AIDS (p is less than .001) and
death (p is less than .001) in Cox-regression controlling
for gestational age, birth year, race and mother's IDU.
Conclusion: In this cohort of HIV-infected children,
breastfeeding was not associated with earlier or more severe
disease. Those breastfed had later AIDS onset, less PCP and
less chronic diahrrea. Due to HIV transmission risk,
however, policies recommending not to breastfeed should not
change.
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