Article

Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial.

Departments of Paediatrics and Medical Microbiology, PO Box 19676, University of Nairobi, Nairobi, Kenya.
The Lancet (Impact Factor: 39.21). 06/2001; 357(9269):1651-5. DOI: 10.1016/S0140-6736(00)04820-0
Source: PubMed

ABSTRACT We have completed a randomised clinical trial of breastfeeding and formula feeding to identify the frequency of breastmilk transmission of HIV-1 to infants. However, we also analysed data from this trial to examine the effect of breastfeeding on maternal death rates during 2 years after delivery. We report our findings from this secondary analysis.
Pregnant women attending four Nairobi city council clinics were offered HIVtests. At about 32 weeks' gestation, 425 HIV-1 seropositive women were randomly allocated to either breastfeed or formula feed their infants. After delivery, mother-infant pairs were followed up monthly during the first year and quarterly during the second year until death, or 2 years after delivery, or end of study.
Mortality among mothers was higher in the breastfeeding group than in the formula group (18 vs 6 deaths, log rank test, p=0.009). The cumulative probability of maternal death at 24 months after delivery was 10.5% in the breastfeeding group and 3.8% in the formula group (p=0.02). The relative risk of death for breastfeeding mothers versus formula feeding mothers was 3.2 (95% CI 1.3-8.1, p=0.01). The attributable risk of maternal death due to breastfeeding was 69%. There was an association between maternal death and subsequent infant death, even after infant HIV-1 infection status was controlled for (relative risk 7.9, 95% CI 3.3-18.6, p<0.001).
Our findings suggest that breastfeeding by HIV-1 infected women might result in adverse outcomes for both mother and infant.

Full-text

Available from: Grace John-Stewart, Jun 03, 2015
0 Followers
 · 
120 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To assess whether pregnancy accelerates HIV disease progression.Methods Studies comparing progression to HIV-related illness, low CD4 count, AIDS-defining illness, HIV-related death, or any death in HIV-infected pregnant and non-pregnant women were included. Relative risks (RR) for each outcome were combined using random effects meta-analysis and were stratified by antiretroviral therapy (ART) availability.Results15 studies met the inclusion criteria. Pregnancy was not associated with progression to HIV-related illness [summary RR: 1.32, 95% confidence interval (CI): 0.66–2.61], AIDS-defining illness (summary RR: 0.97, 95%CI: 0.74–1.25) or mortality (summary RR: 0.97, 95%CI: 0.62–1.53), but there was an association with low CD4 counts (summary RR: 1.41, 95%CI: 0.99–2.02) and HIV-related death (summary RR: 1.65, 95%CI: 1.06–2.57). In settings where ART was available, there was no evidence that pregnancy accelerated progress to HIV/AIDS-defining illnesses, death and drop in CD4 count. In settings without ART availability, effect estimates were consistent with pregnancy increasing the risk of progression to HIV/AIDS-defining illnesses and HIV-related or all-cause mortality, but there were too few studies to draw meaningful conclusions.Conclusions In the absence of ART, pregnancy is associated with small but appreciable increases in the risk of several negative HIV outcomes, but the evidence is too weak to draw firm conclusions. When ART is available, the effects of pregnancy on HIV disease progression are attenuated and there is little reason to discourage healthy HIV-infected women who desire to become pregnant from doing so.
    Tropical Medicine & International Health 10/2014; 20(2). DOI:10.1111/tmi.12412 · 2.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To assess the impact of pregnancy on mortality among HIV-infected Ugandan women initiating ART. Design: Prospective cohort study. Methods: HIV-infected women initiating ART in the Uganda AIDS Rural Treatment Outcomes study were assessed quarterly for self-reported pregnancy. The association between pregnancy and postpartum (‘pregnancy-related’) follow-up periods and mortality was assessed with Cox proportional hazards models adjusted for age, CD4 cell count, plasma HIV-1 RNA levels, and ART duration. Results: Three hundred and fifty-four women with median age 33 years (IQR: 27–37) and CD4 142 cells/μl (IQR: 82–213) were followed for a median of 4.0 years (IQR: 2.5–4.8) after ART initiation, with 3 and 7% loss-to-follow-up at years 1 and 5. One hundred and nine women experienced pregnancy. Five deaths occurred during pregnancy-related follow-up and 16 during nonpregnancy-related follow-up, for crude mortality rates during the first year after ART initiation of 12.57/100 PYs and 3.53/100 PYs (rate ratio 3.56, 95% CI: 0.97–11.07). In adjusted models, the impact of pregnancy-related follow-up on mortality was highest at ART initiation (aHR: 21.48, 95% CI: 3.73–123.51), decreasing to 13.44 (95% CI 3.28–55.11) after 4 months, 8.28 (95% CI 2.38–28.88) after 8 months, 5.18 (95% CI: 1.36–19.71) after 1 year, and 1.25 (95% CI: 0.10–15.58) after 2 years on ART. Four of five maternal deaths occurred postpartum. Conclusion: Pregnancy and the postpartum period were associated with increased mortality in HIV-infected women initiating ART, particularly during early ART. Contraception proximate to ART initiation, earlier ART initiation, and careful monitoring during the postpartum period may reduce maternal mortality in this setting.
    AIDS 10/2013; 27:S105-S112. DOI:10.1097/QAD.0000000000000040 · 6.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: An estimated 260,000 children under the age of 15 years acquired HIV infection in 2012. As much as 42% of mother-to-child transmission is related to breastfeeding. Antiretroviral prophylaxis for mothers or infants has the potential to prevent mother-to-child transmission of HIV through breast milk.
    Cochrane database of systematic reviews (Online) 10/2014; 10(10):CD011323. DOI:10.1002/14651858.CD011323 · 5.70 Impact Factor