Zambia Exclusive Breastfeeding Study (ZEBS)
Infants breastfed by their HIV-infected mothers are at risk of acquiring HIV infection through breast milk. However, in low-resource settings where the HIV epidemic predominates, breastfeeding cannot simply be replaced by breast milk substitutes since alternatives to breast milk are unavailable, unaffordable, and/or unsafe. As a result, breastfeeding poses a dilemma for women who live in low-resource settings and who are infected with HIV. Breastfeeding can transmit HIV but is also the source of optimal nutrition and protection against other serious infectious diseases.
The benefits of breastfeeding for reducing the incidence of complications and death from non-HIV infectious disease, although known to extend into the second year, are greatest in the first few months of life. Early cessation of breastfeeding has been recommended to balance these competing risks favorably—reducing postnatal transmission of HIV while preserving the nutritional and immunologic benefits of breastfeeding at the time when they are needed most.
The CGHD’s Zambia Exclusive Breastfeeding Study (ZEBS) sought to determine which of the competing risks was greater: breast milk transmission of HIV in the case of exclusive breastfeeding or the non-HIV mortality associated with mixed (non-exclusive breastfeeding) or replacement feeding. We found that early, abrupt cessation of breastfeeding by HIV-infected women in a low-resource setting, such as Lusaka, Zambia, does not improve the rate of HIV-free survival among children born to HIV-infected mothers and is harmful to HIV-infected infants.
These results suggest that early, abrupt cessation of breastfeeding for HIV-infected women in low-resource settings should be avoided.
|Principal Investigator||Donald Thea
Louise Kuhn, Co-Principal Investigator
|Boston University Co-Investigators||Grace Aldrovandi, Chipepo Kankasa, Moses Sinkala|
|Dates of Research||2001–2007|