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Breastfeeding, mother-to-child HIV transmission, and mortality among infants born to HIV-Infected women on highly active antiretroviral therapy in rural Uganda.
J Acquir Immune Defic Syndr. 2010 Jan; 53(1):28-35.JA

Abstract

BACKGROUND

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.

DESIGN AND METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Authors+Show Affiliations

Institute for Global Health, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94105, USA. jhomsy@psg.ucsf.eduNo 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

Language

eng

PubMed ID

19797972

Citation

Homsy, Jaco, et al. "Breastfeeding, Mother-to-child HIV Transmission, and Mortality Among Infants Born to HIV-Infected Women On Highly Active Antiretroviral Therapy in Rural Uganda." Journal of Acquired Immune Deficiency Syndromes (1999), vol. 53, no. 1, 2010, pp. 28-35.
Homsy J, Moore D, Barasa A, et al. Breastfeeding, mother-to-child HIV transmission, and mortality among infants born to HIV-Infected women on highly active antiretroviral therapy in rural Uganda. J Acquir Immune Defic Syndr. 2010;53(1):28-35.
Homsy, J., Moore, D., Barasa, A., Were, W., Likicho, C., Waiswa, B., Downing, R., Malamba, S., Tappero, J., & Mermin, J. (2010). Breastfeeding, mother-to-child HIV transmission, and mortality among infants born to HIV-Infected women on highly active antiretroviral therapy in rural Uganda. Journal of Acquired Immune Deficiency Syndromes (1999), 53(1), 28-35. https://doi.org/10.1097/QAI.0b013e3181bdf65a
Homsy J, et al. Breastfeeding, Mother-to-child HIV Transmission, and Mortality Among Infants Born to HIV-Infected Women On Highly Active Antiretroviral Therapy in Rural Uganda. J Acquir Immune Defic Syndr. 2010;53(1):28-35. PubMed PMID: 19797972.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Breastfeeding, mother-to-child HIV transmission, and mortality among infants born to HIV-Infected women on highly active antiretroviral therapy in rural Uganda. AU - Homsy,Jaco, AU - Moore,David, AU - Barasa,Alex, AU - Were,Willi, AU - Likicho,Celina, AU - Waiswa,Bernard, AU - Downing,Robert, AU - Malamba,Samuel, AU - Tappero,Jordan, AU - Mermin,Jonathan, PY - 2009/10/3/entrez PY - 2009/10/3/pubmed PY - 2010/1/20/medline SP - 28 EP - 35 JF - Journal of acquired immune deficiency syndromes (1999) JO - J. Acquir. Immune Defic. Syndr. VL - 53 IS - 1 N2 - BACKGROUND: 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. DESIGN AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. SN - 1944-7884 UR - https://www.unboundmedicine.com/medline/citation/19797972/Breastfeeding_mother_to_child_HIV_transmission_and_mortality_among_infants_born_to_HIV_Infected_women_on_highly_active_antiretroviral_therapy_in_rural_Uganda_ L2 - http://dx.doi.org/10.1097/QAI.0b013e3181bdf65a DB - PRIME DP - Unbound Medicine ER -