Milk Calcium and Phosphorus in Ugandan Women with HIV on Tenofovir-Based Antiretroviral Therapy.

This was an observational secondary analysis of milk minerals, not a randomised trial, and it did not measure infant bone health or growth. The women with HIV took tenofovir disoproxil fumarate, lamivudine and efavirenz together, so the study cannot separate the effects of HIV, the regimen, or any single drug. Milk sampling began at 2 weeks postpartum, so very early lactation changes were not captured. Breastfeeding practices were self-reported and may have overestimated exclusive breastfeeding. Fewer women with HIV were primiparous, which may have biased group comparisons. Milk volume was not measured, so differences in concentration could not be related to total mineral delivered. At 52 weeks, only 40 women with HIV and 55 women without HIV provided milk samples, and the complete-case sensitivity analysis reduced statistical significance.

The authors declared no potential conflicts of interest. The research was funded by the Medical Research Council and the Department for International Development under the MRC/DFID Concordat agreement, and by the Alborada Trust through The Cambridge in Africa Programme. One author's PhD tuition and stipend were funded by the Gates Cambridge Scholarship.

Do not conclude that tenofovir disoproxil fumarate alone changed milk minerals or that breastfeeding is unsafe for women with HIV on ART. The women took tenofovir disoproxil fumarate, lamivudine and efavirenz together, and the paper reports milk mineral concentrations, not infant bone health or growth outcomes.