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Women infected with HIV in sub-Saharan Africa who fed their babies exclusively with breast milk beyond the infant's first four months of life had the lowest risk of transmitting the virus to babies through their milk, according to researchers at Columbia University's Mailman School of Public Health.

Women who are HIV-infected typically have a 10 to 15 percent chance of transmitting the virus to their babies through breast milk. However, due to the rampant infectious diseases in sub-Saharan Africa, breastfeeding is essential to keep infants healthy because it helps developing immune systems fight off infections.

To determine if early weaning could reduce HIV-transmission and infant mortality, Louise Kuhn, PhD, professor of Epidemiology at Columbia University's Mailman School of Public Health and colleagues conducted a random clinical trial examining 950 HIV-infected women in Zambia. The women were recommended to breastfeed their infants from birth for at least four months. At four months, half the women were encouraged to stop breastfeeding, while the others were encouraged to continue. Breast milk was collected from the women at four and half months and infants were regularly tested for possible HIV-transmission throughout the study.

Women who stopped breastfeeding at four months had the highest concentrations of HIV in their breast milk, with 77 percent having detectable concentrations. Of the women who continued to breastfeed exclusively at four and a half months, only 39.5 percent had a detectable concentration of the virus in their breast milk. However, when the two groups were compared just two weeks earlier than four months, the concentration showed no differences.

"Our results have profound implications for prevention of mother to-child HIV transmission programs in settings where breast-feeding is necessary to protect infant and maternal health," wrote Dr. Kuhn, who is affiliated with the Gertrude H. Sergievsky Center at Columbia University Medical Center.

"Our data demonstrate that early and abrupt weaning carries significant risks for infants."

The findings are online in the journal Science Translational Medicine.