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Early mixed feeding and breastfeeding beyond 6 months increase the risk of postnatal HIV transmission: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte d'Ivoire.
Prev Med. 2008 Jul; 47(1):27-33.PM

Abstract

OBJECTIVE

To evaluate the risk of postnatal HIV transmission among women in Abidjan, Côte d'Ivoire offered alternatives to prolonged breastfeeding, and to assess the impact of the breastfeeding pattern and duration on this risk.

METHODS

In 2001-2003, HIV-infected pregnant women received peri-partum antiretroviral prophylaxis and were counselled antenatally regarding infant feeding options: formula feeding or exclusive breastfeeding with early cessation from 4 months of age. The primary outcome was HIV postnatal transmission by 18 months of age, defined by a positive HIV test after a negative test > or =30 days. The effect of the pattern (mixed feeding, defined as breastmilk plus food-based fluid, solid food or non-human milk) and duration (less vs. more than 6 months) of breastfeeding on postnatal transmission was assessed.

RESULTS

Of 622 live-born infants who were HIV uninfected at or after 30 days, 15 were infected postnatally, 13/324 among breastfed, and 2/298 among formula-fed infants. The 18-month probability of remaining free from HIV infection was 0.95 [95% CI, 0.92-0.97] and 0.99 [95% CI, 0.97-1.00] in the breastfeeding and formula-feeding groups respectively (p<0.001). In adjusted analysis, breastfeeding for more than 6 months and mixed feeding during the first month of life were independently associated with a 7.5 (AOR 95% CI, 2.0-28.2, p=0.003)- and a 6.3 (95% CI, 1.1-36.4, p=0.04)-fold increase of postnatal transmission among breastfed children.

CONCLUSIONS

Mixed feeding during the first month of life and breastfeeding beyond 6 months are strong determinants of HIV transmission and should be avoided when replacement feeding after breastfeeding cessation can be safely and sustainably provided.

Authors+Show Affiliations

INSERM, Unité 897, Centre de Recherche Epidémiologie et Biostatistique, Bordeaux, France. Renaud.Becquet@isped.u-bordeaux2.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18190955

Citation

Becquet, Renaud, et al. "Early Mixed Feeding and Breastfeeding Beyond 6 Months Increase the Risk of Postnatal HIV Transmission: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte D'Ivoire." Preventive Medicine, vol. 47, no. 1, 2008, pp. 27-33.
Becquet R, Ekouevi DK, Menan H, et al. Early mixed feeding and breastfeeding beyond 6 months increase the risk of postnatal HIV transmission: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte d'Ivoire. Prev Med. 2008;47(1):27-33.
Becquet, R., Ekouevi, D. K., Menan, H., Amani-Bosse, C., Bequet, L., Viho, I., Dabis, F., Timite-Konan, M., & Leroy, V. (2008). Early mixed feeding and breastfeeding beyond 6 months increase the risk of postnatal HIV transmission: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte d'Ivoire. Preventive Medicine, 47(1), 27-33. https://doi.org/10.1016/j.ypmed.2007.11.014
Becquet R, et al. Early Mixed Feeding and Breastfeeding Beyond 6 Months Increase the Risk of Postnatal HIV Transmission: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte D'Ivoire. Prev Med. 2008;47(1):27-33. PubMed PMID: 18190955.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early mixed feeding and breastfeeding beyond 6 months increase the risk of postnatal HIV transmission: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte d'Ivoire. AU - Becquet,Renaud, AU - Ekouevi,Didier K, AU - Menan,Hervé, AU - Amani-Bosse,Clarisse, AU - Bequet,Laurence, AU - Viho,Ida, AU - Dabis,François, AU - Timite-Konan,Marguerite, AU - Leroy,Valériane, AU - ,, Y1 - 2007/12/04/ PY - 2007/07/13/received PY - 2007/11/21/revised PY - 2007/11/28/accepted PY - 2008/1/15/pubmed PY - 2008/12/17/medline PY - 2008/1/15/entrez SP - 27 EP - 33 JF - Preventive medicine JO - Prev Med VL - 47 IS - 1 N2 - OBJECTIVE: To evaluate the risk of postnatal HIV transmission among women in Abidjan, Côte d'Ivoire offered alternatives to prolonged breastfeeding, and to assess the impact of the breastfeeding pattern and duration on this risk. METHODS: In 2001-2003, HIV-infected pregnant women received peri-partum antiretroviral prophylaxis and were counselled antenatally regarding infant feeding options: formula feeding or exclusive breastfeeding with early cessation from 4 months of age. The primary outcome was HIV postnatal transmission by 18 months of age, defined by a positive HIV test after a negative test > or =30 days. The effect of the pattern (mixed feeding, defined as breastmilk plus food-based fluid, solid food or non-human milk) and duration (less vs. more than 6 months) of breastfeeding on postnatal transmission was assessed. RESULTS: Of 622 live-born infants who were HIV uninfected at or after 30 days, 15 were infected postnatally, 13/324 among breastfed, and 2/298 among formula-fed infants. The 18-month probability of remaining free from HIV infection was 0.95 [95% CI, 0.92-0.97] and 0.99 [95% CI, 0.97-1.00] in the breastfeeding and formula-feeding groups respectively (p<0.001). In adjusted analysis, breastfeeding for more than 6 months and mixed feeding during the first month of life were independently associated with a 7.5 (AOR 95% CI, 2.0-28.2, p=0.003)- and a 6.3 (95% CI, 1.1-36.4, p=0.04)-fold increase of postnatal transmission among breastfed children. CONCLUSIONS: Mixed feeding during the first month of life and breastfeeding beyond 6 months are strong determinants of HIV transmission and should be avoided when replacement feeding after breastfeeding cessation can be safely and sustainably provided. SN - 0091-7435 UR - https://www.unboundmedicine.com/medline/citation/18190955/Early_mixed_feeding_and_breastfeeding_beyond_6_months_increase_the_risk_of_postnatal_HIV_transmission:_ANRS_1201/1202_Ditrame_Plus_Abidjan_Côte_d'Ivoire_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-7435(07)00493-8 DB - PRIME DP - Unbound Medicine ER -