Kirsten A Bork 1, Amandine Cournil 1, Jennifer S Read 1, Marie-Louise Newell 1, Cécile Cames 1, Nicolas Meda 1, Stanley Luchters 1, Grace Mbatia 1, Kevindra Naidu 1, Philippe Gaillard 1, Isabelle de Vincenzi 1
Affiliation
- 1From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV).
PMID: 25411291 PMCID: PMC4232020
Abstract
Background: Refraining from breastfeeding to prevent HIV transmission has been associated with increased morbidity and mortality in HIV-exposed African infants.
Objective: The objective was to assess risks of common and serious infectious morbidity by feeding mode in HIV-exposed, uninfected infants ≤6 mo of age with special attention to the issue of reverse causality.
Design: HIV-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the prevention of mother-to-child transmission Kesho Bora trial and counseled to either breastfeed exclusively and cease by 6 mo postpartum or formula feed exclusively. Maternal-reported morbidity (fever, diarrhea, and vomiting) and serious infectious events (SIEs) (gastroenteritis and lower respiratory tract infections) were investigated for 751 infants for 2 age periods (0-2.9 and 3-6 mo) by using generalized linear mixed models with breastfeeding as a time-dependent variable and adjustment for study site, maternal education, economic level, and cotrimoxazole prophylaxis.
Results: Reported morbidity was not significantly higher in nonbreastfed compared with breastfed infants [OR: 1.31 (95% CI: 0.97, 1.75) and 1.21 (0.90, 1.62) at 0-2.9 and 3-6 mo of age, respectively]. Between 0 and 2.9 mo of age, never-breastfed infants had increased risks of morbidity compared with those of infants who were exclusively breastfed (OR: 1.49; 95% CI: 1.01, 2.2; P = 0.042). The adjusted excess risk of SIEs in nonbreastfed infants was large between 0 and 2.9 mo (OR: 6.0; 95% CI: 2.2, 16.4; P = 0.001). Between 3 and 6 mo, the OR for SIEs was sensitive to the timing of breastfeeding status, i.e., 4.3 (95% CI: 1.2, 15.3; P = 0.02) when defined at end of monthly intervals and 2.0 (95% CI: 0.8, 5.0; P = 0.13) when defined at the beginning of intervals. Of 52 SIEs, 3 mothers reported changes in feeding mode during the SIE although none of the mothers ceased breastfeeding completely.
Conclusions: Not breastfeeding was associated with increased risk of serious infections especially between 0 and 2.9 mo of age. The randomized controlled trial component of the Kesho Bora study was registered at Current Controlled Trials (www.controlled-trials.com) as ISRCTN71468401.
Keywords: Africa; HIV/AIDS; diarrhea; infant feeding; infections.
© 2014 American Society for Nutrition.
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