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ATTENTION PHM. NOTE INTERPRETATION AND RECOMMENDATIONS.<br>
<br>
<p class="MsoNormal" style=""><b><span
style="font-size: 18pt; font-family: Shaker2Lancet-Bold; color: rgb(35, 31, 32);"
lang="EN-GB"><br>
</span></b></p>
<p class="MsoNormal" style=""><b><span
style="font-size: 18pt; font-family: Shaker2Lancet-Bold; color: rgb(35, 31, 32);"
lang="EN-GB">Mother-to-child
transmission of HIV-1 infection during exclusive breastfeeding in the
first 6
months of life:<o:p></o:p>an intervention
cohort study<o:p></o:p></span></b></p>
<p class="MsoNormal" style=""><i><span
style="font-size: 8.5pt; font-family: Shaker2Lancet-Italic; color: rgb(180, 7, 56);"
lang="EN-GB">Hoosen M Coovadia,
Nigel C Rollins, <st1:PersonName productid="Ruth M" w:st="on">Ruth M</st1:PersonName>
Bland, Kirsty Little, Anna Coutsoudis, Michael L Bennish, Marie-Louise
Newell</span></i><br>
Lancet 2007; 369: 1107–16<br>
</p>
<p class="MsoNormal" style=""><b><span
style="font-size: 11pt; font-family: Shaker2Lancet-Bold; color: rgb(180, 7, 56);"
lang="EN-GB">Summary<o:p></o:p></span></b></p>
<p class="MsoNormal" style=""><b><span
style="font-size: 9pt; font-family: Shaker2Lancet-Bold; color: rgb(180, 7, 56);"
lang="EN-GB">Background </span></b><b><span
style="font-size: 9pt; font-family: ScalaLancetPro-Bold; color: rgb(35, 31, 32);"
lang="EN-GB">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.<o:p></o:p></span></b></p>
<p class="MsoNormal" style=""><b><span
style="font-size: 9pt; font-family: Shaker2Lancet-Bold; color: rgb(180, 7, 56);"
lang="EN-GB">Methods </span></b><b><span
style="font-size: 9pt; font-family: ScalaLancetPro-Bold; color: rgb(35, 31, 32);"
lang="EN-GB">2722 HIV-infected
and uninfected pregnant women attending antenatal clinics in <st1:place
w:st="on"><st1:City w:st="on">KwaZulu Natal</st1:City>, <st1:country-region
w:st="on">South Africa</st1:country-region></st1:place>
(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<o:p></o:p></span></b></p>
<p class="MsoNormal" style=""><b><span
style="font-size: 9pt; font-family: ScalaLancetPro-Bold; color: rgb(35, 31, 32);"
lang="EN-GB">maternal and infant
factors.<o:p></o:p></span></b></p>
<p class="MsoNormal" style=""><b><span
style="font-size: 9pt; font-family: Shaker2Lancet-Bold; color: rgb(180, 7, 56);"
lang="EN-GB">Findings </span></b><b><span
style="font-size: 9pt; font-family: ScalaLancetPro-Bold; color: rgb(35, 31, 32);"
lang="EN-GB">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 <st1:metricconverter productid="2500 g" w:st="on">2500 g</st1:metricconverter>
(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).<o:p></o:p></span></b></p>
<p class="MsoNormal" style=""><b><span
style="font-size: 9pt; font-family: Shaker2Lancet-Bold; color: rgb(180, 7, 56);"
lang="EN-GB">Interpretation </span></b><b><span
style="font-size: 9pt; font-family: ScalaLancetPro-Bold; color: rgb(35, 31, 32);"
lang="EN-GB">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.<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="" lang="EN-GB"><o:p> </o:p></span></p>
<p class="MsoNormal" style=""><br>
<i><span
style="font-size: 8.5pt; font-family: Shaker2Lancet-Italic; color: rgb(180, 7, 56);"
lang="EN-GB"><o:p></o:p></span></i></p>
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