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 in HIV-positive lactating mothers attending a community health center in peri-urban KwaZulu-Natal, South Africa. The supplemented group included 66 mothers and the control group 63 mothers; all received standard PMTCT care and multivitamin supplementation, and infants were followed for growth and infection outcomes through 9 months.

Daily oral 50 g Sibusiso ready food supplement, a peanut/soya milk spread enriched with micronutrients, providing 280 kcal and 8 g protein per serving. The supplement was taken for a median of 5.5 months and was compared with non-nutritive household supplies.

Overall, the nutritional supplement did not significantly improve maternal or infant health outcomes. Maternal anthropometric and body composition changes were not significantly different between groups at 14 weeks or 6 months, although in the BMI 24.9 kg/m2 or lower subgroup, lean body mass loss was smaller with supplementation than with control (1.32 kg vs 3.17 kg; p = 0.026). Infant outcomes were also largely null: early differences in MUAC, triceps skinfold, and BMI at 14 weeks were no longer significant after adjustment, and there were no significant differences in opportunistic infections or developmental scores. Four infant deaths occurred, all in HIV-infected infants with gastroenteritis-related morbidity; adherence problems were noted as a likely reason for the limited overall effect.

The trial was relatively small and the overall effect was limited by adherence problems, with 33.3% not consuming the full daily amount and sweetness cited as the main reason. The only clear benefit appeared in a small low-BMI subgroup, which limits generalizability and raises the possibility of chance findings. Follow-up was also relatively short for some outcomes, and routine use without targeting appears unsupported.