| Title | Frequency of Gastroenteritis and Gastroenteritis-Associated Mortality with Early Weaning in HIV-1-Uninfected Children Born to HIV-Infected Women in Malawi. | | Author(s) | Kafulafula G, Hoover DR, Taha TE, Thigpen M, Li Q, Fowler MG, Kumwenda NI, Nkanaunena K, Mipando L, Mofenson LM | | Institution | From the *Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi; daggerDepartment of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ; double daggerJohns Hopkins University Bloomberg School of Public Health, Baltimore, MD; section signEpidemiology Branch, Division of HIV/AIDS Prevention, Surveillance, and Epidemiology National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; paragraph signMulago Hospital, Makerere University, MU-JHU Research House, Kampala, Uganda; ||College of Medicine-Johns Hopkins University-Ministry of Health Research Project, Blantyre, Malawi; and section signPediatric, Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD. | | Source | J Acquir Immune Defic Syndr 2009 Oct 20. | | Abstract | BACKGROUND:: We assessed gastroenteritis (GE) burden in 2 randomized trials conducted in Malawi to reduce postnatal HIV transmission before and after World Health Organization recommendations regarding exclusive breastfeeding for HIV-exposed infants were adopted. The 2 trials were the nevirapine/AZT (NVAZ, 2000-2003 with prolonged breastfeeding) and the Postexposure Prophylaxis to the Infant (PEPI, 2004-2007 with breastfeeding cessation by 6 months).
METHODS:: From NVAZ and PEPI trials data, GE frequency through age 12 months among HIV-negative exposed infants was evaluated. Overall and GE-related cumulative mortality rates were estimated using Kaplan-Meier curves.
RESULTS:: The frequency of at least one GE-related hospitalization was greater in PEPI vs. NVAZ after age 6 months (respectively, 2.9% vs. 0.1%, at 7-9 months and 1.6% vs. 0.2% at 10-12 months, P < 0.001). Cumulative GE-related mortality was significantly higher in PEPI than in NVAZ after age 6 months; at ages 9 and 12 months GE-related mortality was 19 and 24 per 1000 infants in PEPI vs. 7 and 12 per 1000 infants in NVAZ (P = 0.0002).
CONCLUSIONS:: Early weaning was associated with increased risk of severe GE and GE-related mortality among HIV-exposed infants. Strategies are urgently needed which allow longer breastfeeding while reducing the risk of HIV breast milk transmission in resource-limited settings. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19844183 |
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