Amandine Cournil 1, Philippe Van de Perre, Cécile Cames, Isabelle de Vincenzi, Jennifer S Read, Stanley Luchters, Nicolas Meda, Kevi Naidu, Marie-Louise Newell, Kirsten Bork; Kesho Bora Study Group
Collaborators
- Kesho Bora Study Group:
Bobo Dioulasso, Burkina Faso, Nicolas Meda, Paulin Fao, Odette Ky-Zerbo, Clarisse Gouem, Paulin Somda, Hervé Hien, Patrice Elysée Ouedraogo, Dramane Kania, Armande Sanou, Ida Ayassou Kossiwavi, Bintou Sanogo, Moussa Ouedraogo, Issa Siribie, Diane Valéa, Sayouba Ouedraogo, François Rouet, Nigel Rollins, Lynne McFetridge, Kevi Naidu, Marcel Reyners, Eunice Irungu, Christine Katingima, Mary Mwaura, Gina Ouattara, Kishor Mandaliya, Sammy Wambua, Mary Thiongo, Ruth Nduati, Judith Kose, Ephantus Njagi, Peter Mwaura, Marie-Louise Newell, Stephen Mepham, Johannes Viljoen, Ruth Bland, Londiwe Mthethwa, Brigitte Bazin, Claire Rekacewicz, Allan Taylor, Nicole Flowers, Michael Thigpen, Mary Glenn Fowler, Denise Jamieson, Lynne M Mofenson, Jennifer S Read, Kirsten Bork, Cécile Cames, Amandine Cournil, Patricia Claeys, Marleen Temmerman, Stanley Luchters, Philippe Van de Perre, Pierre Becquart, Vincent Foulongne, Michel Segondy
Affiliation
- 1From the *UMI 233, Institut de Recherche pour le Développement, Université Montpellier 1, Montpellier, France; †Department of Bacteriology-Virology, Institut National de la Santé et de la Recherche Médicale (INSERM) U1058; Université Montpellier and CHRU Montpellier, Montpellier, France; ‡Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; §National Institutes of Health, Bethesda, Maryland; ¶International Centre for Reproductive Health (ICRH), Mombasa, Kenya; ‖International Centre for Reproductive Health, Ghent University, Ghent, Belgium; **Centre Muraz, Bobo-Dioulasso, Burkina Faso; ††University of KwaZulu-Natal, Durban, South Africa; ‡‡Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa; and §§The Kesho Bora Study Group members are listed in the Appendix.
PMID: 25741969
DOI: 10.1097/INF.0000000000000512
Abstract
Objective: To investigate the association between feeding patterns and HIV-free survival in children born to HIV-infected mothers and to clarify whether antiretroviral (ARV) prophylaxis modifies the association.
Methods: From June 2005 to August 2008, HIV-infected pregnant women were counseled regarding infant feeding options, and randomly assigned to triple-ARV prophylaxis (triple ARV) until breastfeeding cessation (BFC) before age 6 months or antenatal zidovudine with single-dose nevirapine (short-course ARV). Eighteen-month HIV-free survival of infants HIV-negative at 2 weeks of age was assessed by feeding patterns (replacement feeding from birth, BFC <3 months, BFC ≥3 months).
Results: Of the 753 infants alive and HIV-negative at 2 weeks, 28 acquired infection and 47 died by 18 months. Overall HIV-free survival at 18 months was 0.91 [95% confidence interval (CI): 0.88-0.93]. In the short-course ARV arm, HIV-free survival (0.88; CI: 0.84-0.91) did not differ by feeding patterns. In the triple ARV arm, overall HIV-free survival was 0.93 (CI: 0.90-0.95) and BFC <3 months was associated with lower HIV-free survival than BFC ≥3 months (adjusted hazard ratio: 0.36; CI: 0.15-0.83) and replacement feeding (adjusted hazard ratio: 0.20; CI: 0.04-0.94). In the triple ARV arm, 4 of 9 transmissions occurred after reported BFC (and 5 of 19 in the short-course arm), indicating that some women continued breastfeeding after interruption of ARV prophylaxis.
Conclusions: In resource-constrained settings, early weaning has previously been associated with higher infant mortality. We show that, even with maternal triple-ARV prophylaxis during breastfeeding, early weaning remains associated with lower HIV-free survival, driven in particular by increased mortality.
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