Breastfeeding, Mother-to-Child HIV Transmission, and Mortality Among Infants Born to HIV-Infected Women on Highly Active Antiretroviral Therapy in Rural Uganda

Institute for Global Health, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94105, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 09/2009; 53(1):28-35. DOI: 10.1097/QAI.0b013e3181bdf65a
Source: PubMed


Highly active antiretroviral therapy (HAART) drastically reduces mother-to-child transmission of HIV, but where breastfeeding is the only safe infant feeding option, HAART for the prevention of mother-to-child transmission needs to be evaluated in relation to both HIV transmission and infant mortality.
One hundred and two > or = 18-year old women on HAART in rural Uganda who delivered one or more live infants between March 1, 2003 and January 1, 2007 were enrolled in a prospective study to assess HIV transmission and infant survival. All pregnant women were counseled to exclusively breastfeed for 3-6 months according to national guidelines at the time. Infants were followed-up for > or = 7 months and were offered HIV polymerase chain reaction testing quarterly from 6 weeks of age until > or = 6 weeks after complete weaning.
Of 118 infants born during follow-up, 109 (92%) were breastfed. Median durations of exclusive and total breastfeeding were 4 months (interquartile range 3-6) and 5 months (interquartile range 3-7), respectively. None of the infants tested HIV polymerase chain reaction positive over follow-up but 16 infants died without a definitive HIV status at a median age of 2.6 months. In total, 23 (19%) infants died during follow-up at a median age of 3.7 months; 15 (65%) of whom with severe diarrhea and/or vomiting in the week preceding their death. In multivariate analysis, there was a 6-fold greater risk of death among infants breastfed for less than 6 months independent of maternal CD4 count closest to delivery, maternal marital status or maternal death (adjusted hazard ratio = 6.19; 95% confidence interval 1.41-27.0, P = 0.015).
In resource-constrained settings, HIV-infected pregnant women should be assessed for HAART eligibility and treated as needed without delay, and should be encouraged to breastfeed their infants for at least 6 months.

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    • "se ( Bode et al . , 2012 ) . With highly active antiretroviral therapy ( HAART ) less than 3% of breastfed infants will contract HIV . In a study of 102 HIV - infected mothers undergoing HAART in Uganda , no infants were diagnosed as HIV pos - itive and the risk of infant death was six - fold higher among infants breastfed for less than 6 months ( Homsy et al . , 2010 ) . In developing countries breastfeeding in conjunction with HAART may be prefera - ble to formula feeding despite the non - zero risk of HIV transmission ."
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    Applied and Translational Genomics 12/2013; 2(1). DOI:10.1016/j.atg.2013.06.001
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    • "This review did not aim to estimate the risk of suboptimal feeding practices among children born to HIV-infected mothers and is therefore limited by the inability to generalize our findings to such populations. Several studies suggest the benefits of exclusive breastfeeding among children born to HIV-infected mothers during the first six months of life [29,30], and the current WHO/UNICEF recommendation supports this practice and continued feeding during the first year in conjunction with ARV drugs during the breastfeeding period [31]. However, further research is necessary in order to confirm the relevance of our reported effect sizes among HIV-infected mothers and infants. "
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    BMC Public Health 09/2013; 13 Suppl 3(Suppl 3):S18. DOI:10.1186/1471-2458-13-S3-S18 · 2.26 Impact Factor
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