Preventing mother to child transmission of HIV through breastfeeding: Exclusive breastfeeding, mastitis, viral load and early cessation

Abstract

Background. Exclusive breastfeeding followed by early cessation of breastfeeding at six months is commonly recommended to HIV infected mothers; however, little is known either about the protective mechanisms of exclusive breastfeeding or the experiences of mothers who stop breastfeeding early. Methods. My study combines an archived sample study comparing breastmilk and plasma samples among exclusive breastfeeding and mixed breastfeeding mothers who either did or did not transmit HIV to their infant with a qualitative study of mother's experiences with early cessation in rural Zimbabwe. Samples were tested for viral load, and sub-clinical mastitis. The qualitative study included 15 interviews with HIV infected mothers EBF their babies, 12 interviews and dietary recalls with HIV infected mothers attempting to stop breastfeeding plus 16 dietary recalls with HIV status unknown mothers.;Results. Exclusive breastfeeding was not associated with either sub-clinical mastitis or breastmilk viral load; sub-clinical mastitis was directly associated with breastmilk viral load and this effect increased with increasing maternal plasma viral load; and sub-clinical mastitis was associated with postnatal transmission only when maternal plasma viral load was high (>4 logs). Eventually 11 of the 12 mothers who attempted to stop breastfeeding were able to do so; however, none of the infants received adequately nutritious diets. Factors that supported mothers in their decision to stop breastfeeding included fear of transmitting HIV to their child, family support, the ability to discuss their feeding decisions with family members, and their ability to reveal their status to family. The greatest barrier to early cessation of breastfeeding was a lack of food and the mother's perception that she would not be able to provide her child with an adequate diet.;Conclusions. This study provides evidence that mastitis may not be associated with increased HIV transmission at lower plasma viral loads, and offers some insight into the dynamics of viral load in blood and milk, as well as the potential role of anti-infective factors. Although a motivated group of mothers existed who were willing to and did stop breastfeeding, they were unable to provide their child with an adequate replacement diet.