PHA-Exchange> MTC transmission of HIV and Breastfeeding

[claudio at hcmc.netnam.vn]

 from Maria <maria at mundonica.com> -----

ATTENTION.  NOTE INTERPRETATION AND RECOMMENDATIONS.

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*Mother-to-child transmission of HIV-1 infection during exclusive 
breastfeeding in the first 6 months of life:an intervention cohort study*

/Hoosen M Coovadia, Nigel C Rollins, Ruth M Bland, Kirsty Little, Anna 
Coutsoudis, Michael L Bennish, Marie-Louise Newell/
 Lancet 2007; 369: 1107--16

*Summary*

*Background **Exclusive breastfeeding, though better than other forms of 
infant feeding and associated with improved child survival, is uncommon. 
We assessed the HIV-1 transmission risks and survival associated with 
exclusive breastfeeding and other types of infant feeding.*

*Methods **2722 HIV-infected and uninfected pregnant women attending 
antenatal clinics in KwaZulu Natal, South Africa (seven rural, one 
semiurban, and one urban), were enrolled into a non-randomised 
intervention cohort study. Infant feeding data were obtained every week 
from mothers, and blood samples from infants were taken monthly at 
clinics to establish HIV infection status. Kaplan-Meier analyses 
conditional on exclusive breastfeeding were used to estimate 
transmission risks at 6 weeks and 22 weeks of age, and Cox's 
proportional hazard was used to quantify associations with*

*maternal and infant factors.*

*Findings **1132 of 1372 (83%) infants born to HIV-infected mothers 
initiated exclusive breastfeeding from birth. Of 1276 infants with 
complete feeding data, median duration of cumulative exclusive 
breastfeeding was 159 days (first quartile [Q1] to third quartile [Q3], 
122--174 days). 14·1% (95% CI 12·0--16·4) of exclusively breastfed 
infants were infected with HIV-1 by age 6 weeks and 19·5% (17·0--22·4) 
by 6 months; risk was significantly associated with maternal CD4-cell 
counts below 200 cells per µL (adjusted hazard ratio [HR] 3·79; 
2·35--6·12) and birthweight less than 2500 g (1·81, 1·07--3·06). 
Kaplan-Meier estimated risk of acquisition of infection at 6 months of 
age was 4·04% (2·29--5·76). Breastfed infants who also received solids 
were signifi cantly more likely to acquire infection than were 
exclusively breastfed children (HR 10·87, 1·51--78·00, p=0·018), as were 
infants who at 12 weeks received both breastmilk and formula milk (1·82, 
0·98--3·36, p=0·057). Cumulative 3-month mortality in exclusively 
breastfed infants was 6·1% (4·74--7·92) versus 15·1% (7·63--28·73) in 
infants given replacement feeds (HR 2·06, 1·00--4·27, p=0·051).*

*Interpretation **The association between mixed breastfeeding and 
increased HIV transmission risk, together with evidence that exclusive 
breastfeeding can be successfully supported in HIV-infected women, 
warrant revision of the present UNICEF, WHO, and UNAIDS infant feeding 
guidelines.*

 


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