Absence of breastfeeding or early breastfeeding cessaction even in the presence of HIV infection has been shown
to be associated with increased morbidity and mortality in the infants [12–17]. In addition, the 2006 CDC inves-
tigation into a diarrhoeal outbreak in Botswana reported significant risk for mortality associated with non-
breastfeeding in both HIV exposed and unexposed infants [18].
These findings along with the evidence of the efficacy of antiretroviral prophylaxis (given either to the mother or
infant) to reduce HIV transmission [15–17, 19] resulted in the formulation of the new WHO PMTCT (prevention of
mother to child transmission of HIV) and infant feeding guidelines in 2010 [20]. However some concern has previously been expressed that the combined metabolic burdens of HIV infection and breastfeeding in a population that has inadequate nutritional intake could lead to substantial nutritional impairment and that lactation may affect HIV replication [21].
Although there appears to be strong evidence that lactation has no adverse impact on mortality in HIV-infected
women [22–33] there is insufficient evidence regarding its effect on the nutritional status, mental health and disease
progression of these women.
Studies of HIV-infected individuals have suggested that mortality is correlated with loss of lean tissue rather than
overall weight loss [24, 25]. We therefore investigated the impact of lactation on body composition as well as other health parameters of HIV-infected lactating mothers compared to non-lactating mothers in a semi-urban economically unstable community. In addition infants born to the mothers were assessed in terms of nutritional status, development and morbidity. According to the prevailing guidelines at the time of the study, HIV-positive breastfeeding mothers were supported to practice exclusive breastfeeding for 6 months, and thereafter those mothers whose infants tested HIV-negative were counseled on either discontinuing breastfeeding at 6 months, or heat-treating expressed breast milk (HTEBM)
[26–28].