Lipid-Based Nutrient Supplements Are Feasible As a Breastmilk Replacement for HIV-Exposed Infants from 24 to 48 Weeks of Age

Carolina Population Center.
Journal of Nutrition (Impact Factor: 4.23). 03/2013; 143(5). DOI: 10.3945/jn.112.168245
Source: PubMed

ABSTRACT The Breastfeeding, Antiretrovirals, and Nutrition (BAN) Study randomized HIV-infected mothers and their infants to receive either maternal lipid-based nutrient supplements (LNS) during lactation or no LNS and then to 1 of 3 antiretroviral drug (ARV) arms (maternal, infant, or no drugs). Assigned interventions were provided from 0 to 28 wk and all infants (n = 1619) were given LNS during (24-28 wk) and following (28-48 wk) weaning. This paper assesses the feasibility of infant LNS as a breastmilk replacement and uses longitudinal random effects models to examine associations of interventions, morbidity, and season with weight-for-age (WAZ), length-for-age (LAZ), and BMI-for-age (BMIZ) Z-scores from 24 to 48 wk. Infant LNS adherence was high (94.1% ate it daily). From 24 to 48 wk, mean WAZ (-0.42 to -0.76 SD; P < 0.001) and LAZ (-0.93 to -1.56 SD; P < 0.001) steadily declined, whereas BMIZ remained >0 throughout. A higher LAZ was associated with assignment to the maternal LNS arm (β=0.19; P < 0.05). Lower WAZ and BMIZ were associated with seasonal food insecurity (β=-0.08 and -0.09, respectively; both P < 0.001), fever (β=-0.07 and -0.13; both P < 0.001), diarrhea (β=-0.19 and -0.23; both P < 0.001), and assignment to the infant ARV arm (β=-0.17 and -0.17; both P < 0.05). The magnitude of the season and morbidity effects was small and BAN infants had higher weights and lengths than their counterparts in the general population. High LNS adherence and the modest impact of morbidity on growth indicate that LNS is a feasible breastmilk replacement for HIV-exposed infants weaned early, but controlled trials are needed to quantify the effects of LNS on growth in this population.

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    ABSTRACT: To compare growth of HIV-exposed children receiving one of two complementary foods following prevention of mother-to-child HIV transmission through maternal lifelong antiretroviral therapy (ART). In rural Malawi, 280 HIV-infected pregnant women were consecutively identified and offered ART, without consideration of their CD4 counts. Mothers were supported to exclusively breastfeed, and children tested for HIV status at 1.5 mo and 5.5 mo of age. From this group, 248 HIV exposed children were enrolled and randomized to receive micronutrients with either whole milk powder or a ready-to-use complementary food (RUF), until the child reached 12 mo of age. Children were followed until 18 mo of age. HIV-free survival at 12 mo was 90% (95%CI 87-94%). Exclusive breastfeeding for the first 6 mo of life was practiced in 97% of the children. At 12 mo of age, 89% of the children continued to be breastfed. At 6 mo of age, infants had a weight-for-height z score (WHZ) of 0.7 ± 1.1 (mean ± SD) and length-for-age z score (LAZ) of -1.3 ± 1.2. The decrease in LAZ among children receiving RUF at 12 mo of age was greater than seen in those receiving milk powder (-0.3 ± 0.8 vs -0.1 ± 0.7, P=0.04). Mean WHZ was > 0 at 12 and 18 mo of age in both groups. HIV-free survival ≥ 90% at 12 mo was achieved with maternal ART, while either milk powder or RUF as a complementary food preserved child anthropometry. Breastfeeding by mothers receiving ART was acceptable.
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