Effect of nutritional supplementation of breastfeeding HIV positive mothers on maternal and child health: findings from a randomized controlled clinical trial

Randomized controlled clinical trial of HIV-positive lactating mothers (Zulu ethnicity) attending the antenatal clinic at Umkhumbane Community Health Centre, Durban, South Africa. Eligibility included mothers planning to breastfeed for at least 6 months; 129 mothers randomized (66 supplementation, 63 control). Allocation concealment via sealed boxes; clinicians blinded by using identical brown bags. Follow-up from 2 weeks post-delivery to 9 months; outcomes included maternal anthropometry and body composition, CD4 counts, haemoglobin and albumin, incidence of opportunistic infections, depression and quality of life; infant anthropometry and development; analyses used GEE and GLM; intention-to-treat.

Peanut/soy milk-based ready-food supplement (Sibusiso ready food supplement), 50 g daily, orally consumed; provides 280 kcal energy and 8 g protein per serving; started about 2 weeks after delivery; median duration 5.5 months (IQR 2.94–6).

The supplement had no significant impact on maternal or infant outcomes overall. In the subset of mothers with BMI ≤ 24.9 kg/m2, lean body mass loss was significantly lower with supplementation (LBM change: -1.32 kg vs -3.71 kg; p = 0.026). No significant impact on infant growth or infections. Conclusion: A 50 g daily nutritional supplement to breastfeeding HIV-positive mothers had no or limited effect on mother and child health outcomes.

Adherence to the supplement was imperfect (33.3% did not consume daily; palatability issues: 39.4% reported the paste was too sweet). The trial was powered to detect a ≥4 kg difference in lean body mass, possibly missing smaller effects. Not all mothers breastfed for the full 6 months, introducing potential confounding. BMI subgroups had small sample sizes; generalizability may be limited.