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To the Editor: In their study of breastfeeding vs formula-feeding among women with human immunodeficiency virus type 1 (HIV-1) in Nairobi, Kenya, Dr Mbori-Ngacha and colleagues¹ found no significant difference in 2-year infant mortality rates. However, I have several concerns about the results of their study, which shows that breastfed infants were more likely to experience the combined end point of death or HIV infection at 2 years.

First, the study's determination of infant HIV-1 status by enzyme-linked immunosorbent assay does not account for the test's capability, which is to look for antibodies rather than the virus itself. Infants in the breastfeeding group might have had high levels due to transmission of the mother's antibodies through breastmilk.

Second, a large number of women in this trial used both breastfeeding and formula feeding. In this study, mixed feeders were assigned to the breastfeeding group, thus creating a substantial bias against success . . . [Full Text of this Article]