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Tshiambara P, Hoffman M, Legodi H, Botha T, Mulol H, Pisa P, Feucht U. Comparison of Feeding Practices and Growth of Urbanized African Infants Aged 6-12 Months Old by Maternal HIV Status in Gauteng Province, South Africa. Nutrients 2023; 15:nu15061500. [PMID: 36986230 PMCID: PMC10053312 DOI: 10.3390/nu15061500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Appropriate feeding practices are protective against malnutrition and poor growth. We compared feeding practices and growth in HIV-exposed-uninfected (HEU) and HIV-unexposed-uninfected (HUU) between 6-12 months of age in urbanized African infants in South Africa. A repeated cross-sectional analysis was used to determine differences in infant feeding practices and anthropometric measures by HIV exposure status at 6, 9, and 12 months in the Siyakhula study. The study included 181 infants (86 HEU; 95 HUU). Breastfeeding rates were lower in HEU vs. HUU infants at 9 (35.6% vs. 57.3%; p = 0.013) and 12 months (24.7% vs. 48.0%; p = 0.005). Introduction to early complementary foods was common (HEU = 16.2 ± 11.0 vs. HUU = 12.8 ± 9.3 weeks; p = 0.118). Lower weight-for-age Z-scores (WAZ) and head circumference-for-age Z-scores (HCZ) were found in HEU infants at birth. At 6 months, WAZ, length-for-age Z-scores (LAZ), HCZ, and mid-upper-arm circumference-for-age Z-scores (MUACAZ) were lower in HEU vs. HUU infants. At 9 months, lower WAZ, LAZ, and MUACAZ were found in HEU vs. HUU infants. At 12 months, lower WAZ, MUACAZ, and weight-for-length Z-scores (-0.2 ± 1.2 vs. 0.2 ± 1.2; p = 0.020) were observed. HEU infants had lower rates of breastfeeding and poorer growth compared to HUU infants. Maternal HIV exposure affects the feeding practices and growth of infants.
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Affiliation(s)
- Phumudzo Tshiambara
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
- Department of Consumer and Food Sciences, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield Campus, Pretoria 0028, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
| | - Marinel Hoffman
- Department of Consumer and Food Sciences, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield Campus, Pretoria 0028, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
| | - Heather Legodi
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield Campus, Pretoria 0028, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
| | - Pedro Pisa
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
| | - Ute Feucht
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
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Mussa A, Taddese HB, Maslova E, Ajibola G, Makhema J, Shapiro RL, Lockman S, Powis KM. Factors Associated with Infant Feeding Choices Among Women with HIV in Botswana. Matern Child Health J 2021; 25:1376-1391. [PMID: 33950327 PMCID: PMC8355043 DOI: 10.1007/s10995-021-03155-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In resource-constrained settings, infant feeding decisions among women with HIV (WHIV) must balance the risk of infant HIV acquisition from breastfeeding with increased mortality associated with formula feeding. WHO guidelines recommend countries principally promote a single feeding method for WHIV, either breastfeeding or formula feeding. In 2016, Botswana revised its policy of formula feeding for infants born to WHIV, instead promoting exclusive breastfeeding during the first 6 months of life. METHODS We sought to understand factors influencing infant feeding choices among WHIV by administering a questionnaire to pregnant and postpartum WHIV (2013-2015) participating in a clinical trial in Botswana (the Mpepu Study). Logistic regression analyses were used to identify factors associated with infant feeding choices. RESULTS Of 810 surveyed participants, 24.0% chose breastfeeding and 76.0% chose formula feeding. Women were more likely to choose formula feeding if advised by a health worker to formula feed (aOR 1.90; 95% CI 1.02-3.57) or if they harboured doubts about the potency of antiretroviral treatment (ART) to prevent infant HIV acquisition (aOR 9.06; 95% CI 4.78-17.17). Women who reported lack of confidence in preparing infant formula safely (aOR 0.09; 95% CI 0.04-0.19) or low concerns about infant HIV acquisition (aOR 0.35; 95% CI 0.22-0.55) were significantly less likely to formula feed. DISCUSSION Perceptions about ART effectiveness, social circumstances and health worker recommendations were key influencers of infant feeding choices among WHIV. Health system factors and maternal education interventions represent ideal targets for any programmatic actions aiming to shape informed decision-making towards HIV-free survival of infants.
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Affiliation(s)
- Aamirah Mussa
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
| | | | | | | | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Roger L Shapiro
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA
| | - Kathleen M Powis
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA
- Divisions of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, USA
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Lane C, Adair L, Bobrow E, Ndayisaba GF, Asiimwe A, Mugwaneza P. Longitudinal interrelationship between HIV viral suppression, maternal weight change, breastfeeding, and length in HIV-exposed and uninfected infants participating in the Kabeho study in Kigali, Rwanda. Ann Epidemiol 2021; 53:1-6.e1. [PMID: 32805400 PMCID: PMC7747133 DOI: 10.1016/j.annepidem.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 06/28/2020] [Accepted: 08/10/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The health of infants that are HIV-exposed and -uninfected (HEU) is a major public health concern as HIV becomes a chronic condition. We investigate the interrelationship between maternal viral suppression, maternal weight status, breastfeeding, and infants that are HEU. METHODS The Kabeho study followed 502 HEU infants in Kigali, Rwanda, for 24 months from 2013 to 2014. We use a structural equation modeling approach to investigate the dynamic relationships between viral suppression, maternal weight change, breastfeeding, and infant length-for-age z-score (LAZ) as defined by the WHO. RESULTS Older mothers are more likely to be virally suppressed and to breastfeed. Viral suppression and the mother being on antiretroviral treatment for longer were related to lower infant LAZ at three months. A more positive maternal weight change was related to higher infant LAZ at the end of each period. At 12 months, a higher infant LAZ was related to increased probability of continued breastfeeding. At 18 months, continued breastfeeding was related to lower LAZ, and food shortages were related to higher LAZ. CONCLUSION There is a complex interrelationship between viral suppression, maternal weight change, breastfeeding, and infant LAZ. These relationships demonstrate the link between maternal and infant health in the context of HIV.
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Affiliation(s)
- Charlotte Lane
- Nutrition Department, University of North Carolina at Chapel Hill, Chapel Hill.
| | - Linda Adair
- Nutrition Department, University of North Carolina at Chapel Hill, Chapel Hill
| | - Emily Bobrow
- Elizabeth Glaser Pediatric AIDS Foundation, Kigali, Rwanda
| | | | - Anita Asiimwe
- Elizabeth Glaser Pediatric AIDS Foundation, Kigali, Rwanda
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Amadhila JN, Van Rensburg GH. Perceptions and experiences of nurse managers of the implementation of the baby and mother friendly initiative in Namibia: a qualitative study. Int Breastfeed J 2020; 15:94. [PMID: 33168038 PMCID: PMC7653859 DOI: 10.1186/s13006-020-00336-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background The baby and mother friendly initiative is a breastfeeding programme in Namibia aimed to protect, promote and support breastfeeding. The purpose of this study was to describe nurse managers’ perceptions and experiences of implementing the baby and mother friendly initiative in order to identify its successes and failures, as well as to develop guidelines for the strengthening of the programme. Methods An evaluation research design to collect qualitative data through face-to-face interviews was conducted. A total of 33 interviews with nurse managers in charge of the baby and mother friendly hospitals, were conducted. Results This study gave insight into the strength and weaknesses in the implementation of the programme implementation and make recommendations for improvement thereof. Four themes emerged from the study, namely: the extent of programme implementation, perceived benefits of the programme, challenges/hindrance to the implementation of the programme and recommendations for strengthening of the programme. The information was used to develop and validate guidelines that would help to strengthen the implementation of the programme. Conclusions The study makes a contribution to the body of knowledge in nursing in that it provides guidelines for the strengthening of the baby and mother programme.
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Affiliation(s)
- Justina N Amadhila
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Ewenighi-Amankwah CO, Onyenekwe CC, Udemba O, Muogbo P, Rong L. A Mother-to-Child Transmission Study in Nigeria: The Impact of Maternal HIV Infection and HAART on Plasma Immunoglobulins, Cytokine Profiles and Infant Outcome. Virol Sin 2020; 35:468-477. [PMID: 32157604 DOI: 10.1007/s12250-020-00202-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/24/2019] [Indexed: 12/18/2022] Open
Abstract
Prevention of mother-to-child transmission (PMTCT) of HIV with highly active antiretroviral therapy (HARRT) allows the HIV+ pregnant mothers to have vaginal delivery and breastfeed. Here we investigated the maternal plasma immunoglobulin, cytokine secretion and the outcome of the exposed infants among the HIV+ HAART treated pregnant women in Nigeria. In this study, different plasma immunoglobulins and cytokines were measured in the HIV+ HAART treated pregnant mothers. Pooled culture supernatants of B and T lymphocytes showed lower levels of IFN-γ, IL-10 and IL-4. There were lower IFN-γ and IL-10 secretions at 1st trimester; however, IL-10 continued to be lower throughout 2nd and 3rd trimesters. TNF-α secretion significantly decreased as pregnancy progressed to term. There were high plasma IgG and low IgM in the HIV+ HAART treated pregnant women. Plasma IgG was high during 1st and 3rd trimesters. After one year of follow up, all the exposed children were seronegative for HIV-1 and HIV-2. Vaginal delivery and breastfeeding among HIV+ HAART treated mothers have shown to be safe. The use of HAART by the infected mothers and the use of septrin and niverapin by the exposed infants prevented mother to-child transmission of HIV.
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Affiliation(s)
- Chinwe O Ewenighi-Amankwah
- Department of Medical Laboratory Science, Ebonyi State University, Abakaliki, 480214, Nigeria. .,Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA.
| | - Charles Chinedum Onyenekwe
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Nnamdi Azikiwe University, Awka, 5025, Nigeria
| | - Ogochukwu Udemba
- Laboratory Unit, Mother of Christ Specialist Hospital, Ogui, Enugu, 400252, Nigeria
| | - Patience Muogbo
- Monitoring and Evaluation Unit, ART Department, Mother of Christ Specialist Hospital, Ogui, Enugu, 400252, Nigeria
| | - Lijun Rong
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA.
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Comparison of Feeding Options for HIV-Exposed Infants: A Retrospective Cohort Study. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1572-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Zweigenthal V, Strebel A, Hunter-Adams J. Adolescent girls' perceptions of breastfeeding in two low-income periurban communities in South Africa. Health Care Women Int 2019; 40:995-1011. [PMID: 30994415 DOI: 10.1080/07399332.2018.1549043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In South Africa, exclusive breastfeeding rates are low, and rates of teenage pregnancy are high. Educational policy enables mothers' return to school, which conflicts with policy emphasizing exclusive breastfeeding. We elicited adolescent women's perceptions and experiences of infant feeding choices, and conducted six focus groups (N = 57) in two periurban settlements. Participants knew arguments in favor of and against breast and formula-feeding, but in practice, mixed feeding occurred early after birth. While completion of high school was emphasized, exclusive breastfeeding was viewed as impractical. Congruent education policies and infant feeding policies/guidelines must address the constraints and contexts of adolescent mothers.
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Affiliation(s)
- Virginia Zweigenthal
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town , Observatory , South Africa
| | - Anna Strebel
- Department of Women's and Gender Studies, University of the Western Cape , Bellville , South Africa
| | - Jo Hunter-Adams
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town , Observatory , South Africa
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Abstract
BACKGROUND HIV-exposed but uninfected (HEU) children may be at an increased risk of impaired growth when compared with their HIV-unexposed and uninfected (HUU) counterparts. We compared the growth patterns of HEU to HUU children in Nigeria. METHODS Pregnant women with and without HIV infection were enrolled at the Plateau State Specialist Hospital, Jos, Nigeria. Infants born to these mothers were recruited at birth and the mother-infant pairs followed up for 18 months. Weight, length and head circumference of the infants were measured at each visit. Age- and sex-standardized Z scores were generated for each anthropometric measure using the World Health Organization Child Growth Standards. Children with length-for-age, weight-for-age and weight-for-length Z scores <-2 were classified as stunted, underweight and wasted, respectively. RESULTS Of 415 children (307 HEU and 108 HUU) recruited for this study, 117 (28.4%), 9 (2.2%) and 32 (7.8%) infants were stunted, underweight and wasted, respectively, at birth. In a multivariable longitudinal analysis, the odds of stunting were higher among HEU as compared with HUU children [adjusted odds ratio: 2.4 (95% confidence interval: 1.4-4.1)]. Similarly, odds of being underweight were higher among the HEU children [adjusted odds ratio: 1.6 (95% confidence interval: 1.1-2.2)]. CONCLUSIONS Linear and ponderal growth were more impaired among HEU as compared with HUU children in Nigeria during the first 18 months of life. Further studies are needed to explore the causal basis for these differences.
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Mulol H, Coutsoudis A. Limitations of maternal recall for measuring exclusive breastfeeding rates in South African mothers. Int Breastfeed J 2018; 13:19. [PMID: 29849742 PMCID: PMC5970480 DOI: 10.1186/s13006-018-0159-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background Maternal recall is most commonly used to determine exclusive breastfeeding rates. A gold standard stable isotope method is available which can determine intake of breast milk versus water from sources other than breast milk and thus objectively determine exclusive breastfeeding. The objectives of this study were to determine exclusive breastfeeding rates by both maternal recall and the objective stable isotope method and discuss the limitations and usefulness of the two methods. Methods The study involved 100 mother-infant pairs in a peri-urban area in Durban, South Africa and study visits took place from July 2012 to September 2014. Maternal recall of exclusive breastfeeding was carried out using the World Health Organization’s 24 hour recall of infant feeding and this was compared to the objective measurement of exclusive breastfeeding using the stable isotope technique at three time points: six weeks, three and 5.5 months. The objective measurements were carried out using two different cut off values for exclusive breastfeeding. Kappa analysis was used to quantify the relationship between maternal recall and results from the stable isotope technique for each mother-infant pair. Results Over reporting of exclusive breastfeeding was common at the three different time points regardless of the cut off value used to assess exclusive breastfeeding by the stable isotope technique. Kappa analysis also revealed only slight or fair agreement (K < 0.24) between reported and measured exclusive breastfeeding at all time points. Conclusions Maternal recall of exclusive breastfeeding is limited in accuracy and should be restricted to large scale epidemiological surveys. The more objective gold standard stable isotope method for measuring intake volumes of breast milk should be used to evaluate interventions with smaller representative samples.
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Affiliation(s)
- Helen Mulol
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Bork KA, Cames C, Newell ML, Read JS, Ayassou K, Musyoka F, Mbatia G, Cournil A. Formula-Feeding of HIV-Exposed Uninfected African Children Is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study. J Nutr 2017; 147:453-461. [PMID: 28122933 DOI: 10.3945/jn.116.242339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/17/2016] [Accepted: 12/21/2016] [Indexed: 11/14/2022] Open
Abstract
Background: Early feeding patterns may affect the growth of HIV-exposed children and thus their subsequent health and cognition.Objective: We assessed the association of infant feeding (IF) mode with length-for-age z score (LAZ) and stunting from age 2 d to 18 mo in HIV-exposed African children within a controlled randomized trial, which evaluated triple antiretrovirals initiated during pregnancy and continued for 6 mo postpartum to prevent HIV transmission.Methods: HIV-infected pregnant women with CD4+ counts of 200-500 cells/mm3 from Burkina Faso, Kenya, and South Africa were advised to exclusively breastfeed for up to 6 mo or to formula-feed from birth. Factors associated with LAZ were investigated in all uninfected children by using mixed-effects linear models; those associated with stunting (LAZ <-2) at 6 or 12 mo were assessed in multiple logistic regression after exclusion of children stunted at age 2 d. Independent variables were IF mode: formula feeding (FF), exclusive breastfeeding (EBF) <3 mo, or EBF ≥3 mo (reference); sex; trial arm; maternal characteristics; and site.Results: Among 728 children, FF was associated with a greater increase in LAZ from 2 d to 6 mo (+0.07 z score/mo, P < 0.001). Between 6 and 18 mo, FF and EBF <3 mo were both associated with greater mean LAZ than was EBF ≥3 mo (+0.52 z scores and +0.43 z scores, respectively, P < 0.001). Among children not stunted at 2 d, FF was independently associated with a reduced risk of stunting at 6 mo (OR: 0.24; 95% CI: 0.07, 0.81; P = 0.021), whereas EBF <3 mo was not (OR: 0.49; 95% CI: 0.22, 1.10; P = 0.09).Conclusions: In this observational study of HIV-exposed uninfected infants, growth in length in the first 6 mo of life was faster in formula-fed infants than in exclusively breastfed infants. The plausibility of residual confounding and reverse causality is discussed. This trial was registered at www.controlled-trials.com as ISRCTN71468401.
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Affiliation(s)
- Kirsten A Bork
- Institut de Recherche pour le Développement UMI233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, Montpellier, France;
| | - Cécile Cames
- Institut de Recherche pour le Développement UMI233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, Montpellier, France
| | - Marie-Louise Newell
- Global Health Research Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jennifer S Read
- University of California at San Francisco, San Francisco, CA
| | | | - Faith Musyoka
- International Centre for Reproductive Health, Mombasa, Kenya; and
| | - Grace Mbatia
- Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya
| | - Amandine Cournil
- Institut de Recherche pour le Développement UMI233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, Montpellier, France
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Ásbjörnsdóttir KH, Slyker JA, Maleche-Obimbo E, Wamalwa D, Otieno P, Gichuhi CM, John-Stewart G. Breastfeeding Is Associated with Decreased Risk of Hospitalization among HIV-Exposed, Uninfected Kenyan Infants. J Hum Lact 2016; 32:NP61-6. [PMID: 26423513 PMCID: PMC4814344 DOI: 10.1177/0890334415607854] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/26/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa, with higher morbidity and mortality than HIV-unexposed infants. HEU infants may experience increased morbidity due to breastfeeding avoidance. OBJECTIVES We sought to describe the burden and identify predictors of hospitalization among HEU infants in the first year of life. METHODS Using a retrospective cohort of HIV-infected mothers and their HEU infants in Nairobi, Kenya, we identified infants who were HIV-uninfected at birth and were followed monthly until their last negative HIV test, death, loss to follow-up, or study exit at 1 year of age. Incidence, timing, and reason for hospitalization was assessed overall as well as stratified by feeding method. Predictors of first infectious disease hospitalization were identified using competing risk regression, with HIV acquisition and death as competing risks. RESULTS Among 388 infants, 113 hospitalizations were reported (35/100 infant-years [the combined years of observation contributed by all infants in the study]; 95% confidence interval [CI], 29-42). Ninety hospitalizations were due to 1 or more infectious diseases (26/100 infant-years; 95% CI, 21-32)-primarily pneumonia (n = 40), gastroenteritis (n = 17), and sepsis (n = 14). Breastfeeding was associated with decreased risk of infectious disease hospitalization (subhazard ratio = 0.39; 95% CI, 0.24-0.64), as was time-updated nutrition status (subhazard ratio = 0.73; 95% CI, 0.61-0.89). Incidence of infectious disease hospitalization among formula-fed infants was 51/100 infant-years (95% CI, 37-70) compared to 19/100 infant-years (95% CI, 14-25) among breastfed infants. CONCLUSION Among HEU infants, breastfeeding and nutrition status were associated with reduced hospitalization during the first year of life.
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Affiliation(s)
| | - Jennifer A Slyker
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Dalton Wamalwa
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | | | - Christine M Gichuhi
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA Department of Medicine, University of Washington, Seattle, WA, USA Department of Pediatrics, University of Washington, Seattle, WA, USA
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Kindra G, Coutsoudis A, Pillay L, Kindness A. Development of predictive equations for total body water using the deuterium-dilution method as the gold standard in a population of asymptomatic HIV-positive Zulu women in South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2012.11734426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mulol H, Coutsoudis A. Breastmilk Output in a Disadvantaged Community with High HIV Prevalence as Determined by the Deuterium Oxide Dose-to-Mother Technique. Breastfeed Med 2016; 11:64-9. [PMID: 26862660 DOI: 10.1089/bfm.2015.0139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION World Health Organization breastfeeding guidelines for HIV-infected mothers are exclusive breastfeeding for 6 months and then continued breastfeeding for 12 months, provided the mother is receiving antiretroviral prophylaxis. Many African women perceive that breastmilk alone is not sufficient for their infant's nutritional requirements for the first 6 months of life, and mixed feeding is a common practice. METHODOLOGY A stable isotope technique was used to determine breastmilk output volumes and maternal body composition objectively at five different time points in the first year of the infant's life. RESULTS Breastmilk output volumes were high for HIV-infected mothers: 831 ± 185 g/day at 6 weeks; 899 ± 188 g/day at 3 months; 871 ± 293 g/day at 6 months; 679 ± 281 g/day at 9 months; and 755 ± 287 g/day at 12 months. These high output volumes had no negative impact on the mother's fat-free mass. The breastmilk output volumes for HIV-uninfected mothers were not significantly different to the outputs for HIV-infected mothers at any of the time points (p > 0.05): 948 ± 223 g/day at 6 weeks; 925 ± 227 g/day at 3 months; 902 ± 286 g/day at 6 months; 746 ± 263 g/day at 9 months; and 713 ± 264 g/day at 12 months. CONCLUSION This study using objective methodology shows that breastmilk outputs of HIV-infected mothers were relatively high (and within published reference ranges), and mothers are able to provide sufficient breastmilk for their infants without compromising their own fat-free mass.
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Affiliation(s)
- Helen Mulol
- Department of Pediatrics and Child Health, University of KwaZulu-Natal , Durban, South Africa
| | - Anna Coutsoudis
- Department of Pediatrics and Child Health, University of KwaZulu-Natal , Durban, South Africa
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Effect of an integrated community-based package for maternal and newborn care on feeding patterns during the first 12 weeks of life: a cluster-randomized trial in a South African township. Public Health Nutr 2015; 18:2660-8. [PMID: 25660465 DOI: 10.1017/s1368980015000099] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To analyse the effect of community-based counselling on feeding patterns during the first 12 weeks after birth, and to study whether the effect differs by maternal HIV status, educational level or household wealth. DESIGN Cluster-randomized trial with fifteen clusters in each arm to evaluate an integrated package providing two pregnancy and five postnatal home visits delivered by community health workers. Infant feeding data were collected using 24 h recall of nineteen food and fluid items. SETTING A township near Durban, South Africa. SUBJECTS Pregnant women (1894 intervention and 2243 control) aged 17 years or more. RESULTS Twelve weeks after birth, 1629 (intervention) and 1865 (control) mother-infant pairs were available for analysis. Socio-economic conditions differed slightly across intervention groups, which were considered in the analyses. There was no effect on early initiation of breast-feeding. At 12 weeks of age the intervention doubled exclusive breast-feeding (OR=2·29; 95 % CI 1·80, 2·92), increased exclusive formula-feeding (OR=1·70; 95 % CI 1·28, 2·27), increased predominant breast-feeding (OR=1·71; 95 % CI 1·34, 2·19), decreased mixed formula-feeding (OR=0·68; 95 % CI 0·55, 0·83) and decreased mixed breast-feeding (OR=0·54; 95 % CI 0·44, 0·67). The effect on exclusive breast-feeding at 12 weeks was stronger among HIV-negative mothers than HIV-positive mothers (P=0·01), while the effect on mixed formula-feeding was significant only among HIV-positive mothers (P=0·03). The effect on exclusive feeding was not different by household wealth or maternal education levels. CONCLUSIONS A perinatal intervention package delivered by community health workers was effective in increasing exclusive breast-feeding, exclusive formula-feeding and decreasing mixed feeding.
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Hart CW, Israel-Ballard KA, Joanis CL, Baniecki ML, Thungu F, Gerrard SE, Kneen E, Sokal DC. Acceptability of a nipple shield delivery system administering antiviral agents to prevent mother-to-child transmission of HIV through breastfeeding. J Hum Lact 2015; 31:68-75. [PMID: 25412617 DOI: 10.1177/0890334414559980] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Breastfeeding is a route of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV). The World Health Organization recommends antiretroviral (ARV) prophylaxis as the best method to prevent mother-to-child transmission of HIV (PMTCT) during breastfeeding. The nipple shield delivery system (NSDS) is being developed as an accessible method to deliver ARVs to infants and PMTCT during breastfeeding. The NSDS can potentially circumvent hygiene and storage issues in delivering drugs to infants in low-resource settings. OBJECTIVES The primary objective was to determine acceptability of the NSDS for PMTCT in Kenya. Secondary objectives included assessing mothers' understanding of MTCT and identifying cultural and implementation issues that might affect NSDS acceptability. METHODS Eleven focus group discussions were conducted, each group consisting of 7 to 12 participants. Seven focus group discussions consisted of HIV-positive mothers, 2 included grandmothers/mothers-in-law, and 2 included fathers/husbands. Ten in-depth interviews were also conducted with individual maternal/child health care providers. Topics included infant feeding and HIV stigma, as well as safety, effectiveness, and feasibility of the NSDS. Device prototypes were used in discussions. RESULTS Participants felt that the NSDS could be trusted if validated scientifically and promoted by health care professionals. HIV-related stigma, access, efficacy, and hygiene were identified as important considerations for acceptance. CONCLUSION The NSDS is a potentially acceptable method of PMTCT during breastfeeding. Further studies are needed to confirm acceptability, safety, and efficacy. For NSDS adoption to PMTCT, strategies will need to be developed to minimize HIV-related stigma and to ensure that continuous hygiene of the device is maintained.
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Affiliation(s)
| | | | | | | | | | - Stephen E Gerrard
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
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Bork KA, Cournil A, Read JS, Newell ML, Cames C, Meda N, Luchters S, Mbatia G, Naidu K, Gaillard P, de Vincenzi I. Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 mo of life: the Kesho Bora study. Am J Clin Nutr 2014; 100:1559-68. [PMID: 25411291 PMCID: PMC4232020 DOI: 10.3945/ajcn.113.082149] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Refraining from breastfeeding to prevent HIV transmission has been associated with increased morbidity and mortality in HIV-exposed African infants. OBJECTIVE The objective was to assess risks of common and serious infectious morbidity by feeding mode in HIV-exposed, uninfected infants ≤6 mo of age with special attention to the issue of reverse causality. DESIGN HIV-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the prevention of mother-to-child transmission Kesho Bora trial and counseled to either breastfeed exclusively and cease by 6 mo postpartum or formula feed exclusively. Maternal-reported morbidity (fever, diarrhea, and vomiting) and serious infectious events (SIEs) (gastroenteritis and lower respiratory tract infections) were investigated for 751 infants for 2 age periods (0-2.9 and 3-6 mo) by using generalized linear mixed models with breastfeeding as a time-dependent variable and adjustment for study site, maternal education, economic level, and cotrimoxazole prophylaxis. RESULTS Reported morbidity was not significantly higher in nonbreastfed compared with breastfed infants [OR: 1.31 (95% CI: 0.97, 1.75) and 1.21 (0.90, 1.62) at 0-2.9 and 3-6 mo of age, respectively]. Between 0 and 2.9 mo of age, never-breastfed infants had increased risks of morbidity compared with those of infants who were exclusively breastfed (OR: 1.49; 95% CI: 1.01, 2.2; P = 0.042). The adjusted excess risk of SIEs in nonbreastfed infants was large between 0 and 2.9 mo (OR: 6.0; 95% CI: 2.2, 16.4; P = 0.001). Between 3 and 6 mo, the OR for SIEs was sensitive to the timing of breastfeeding status, i.e., 4.3 (95% CI: 1.2, 15.3; P = 0.02) when defined at end of monthly intervals and 2.0 (95% CI: 0.8, 5.0; P = 0.13) when defined at the beginning of intervals. Of 52 SIEs, 3 mothers reported changes in feeding mode during the SIE although none of the mothers ceased breastfeeding completely. CONCLUSIONS Not breastfeeding was associated with increased risk of serious infections especially between 0 and 2.9 mo of age. The randomized controlled trial component of the Kesho Bora study was registered at Current Controlled Trials (www.controlled-trials.com) as ISRCTN71468401.
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Affiliation(s)
- Kirsten A Bork
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
| | - Amandine Cournil
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
| | - Jennifer S Read
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
| | - Marie-Louise Newell
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
| | - Cécile Cames
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
| | - Nicolas Meda
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
| | - Stanley Luchters
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
| | - Grace Mbatia
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
| | - Kevindra Naidu
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
| | - Philippe Gaillard
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
| | - Isabelle de Vincenzi
- From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV)
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White AB, Mirjahangir JF, Horvath H, Anglemyer A, Read JS. Antiretroviral interventions for preventing breast milk transmission of HIV. Cochrane Database Syst Rev 2014; 2014:CD011323. [PMID: 25280769 PMCID: PMC10576873 DOI: 10.1002/14651858.cd011323] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND An estimated 260,000 children under the age of 15 years acquired HIV infection in 2012. As much as 42% of mother-to-child transmission is related to breastfeeding. Antiretroviral prophylaxis for mothers or infants has the potential to prevent mother-to-child transmission of HIV through breast milk. OBJECTIVES To determine which antiretroviral prophylactic regimens are efficacious and safe for reducing mother-to-child transmission of HIV through breastfeeding and thereby avert child morbidity and mortality. SEARCH METHODS Using Cochrane Collaboration search methods in conjunction with appropriate search terms, we identified relevant studies from January 1, 1994 to January 14, 2014 by searching databases including Cochrane CENTRAL, EMBASE and PubMed, LILACS, and Web of Science/Web of Social Science. SELECTION CRITERIA Randomized controlled trials in which HIV-infected mothers breastfed their infants, and in which the mothers used antiretroviral prophylaxis while breastfeeding their children or their children received antiretroviral prophylaxis for at least four weeks while breastfeeding, were included. DATA COLLECTION AND ANALYSIS Abstracts of all trials identified were examined independently by two authors. We identified 15,922 references and examined 81 in detail. Data were abstracted independently using a standardized form. MAIN RESULTS Seven RCTs were included in the review.One trial compared triple antiretroviral prophylaxis during pregnancy and breastfeeding with short antiretroviral prophylaxis to given to the mother to prevent mother-to-child transmission of HIV. At 12 months, the risks of HIV transmission, and of HIV transmission or death, were lower, but there was no difference in infant mortality alone in the triple arm versus the short arm. Using the GRADE methodology, evidence quality for outcomes in this trial was generally low to moderate.One trial compared six months of breastfeeding using zidovudine, lamivudine, and lopinavir/ritonavir versus zidovudine, lamivudine, and abacavir from 26-34 weeks gestation. At six months, there was no difference in risk of infant HIV infection, infant death, or infant HIV infection or death between the two groups. Evidence quality for outcomes in this trial was generally very low to low.One trial of single dose nevirapine versus six weeks of infant zidovudine found the risk of HIV infection at 12 weeks to be greater in the zidovudine arm than in the single dose nevirapine arm. Evidence quality for outcomes in this trial was generally very low.One multi-country trial compared single dose nevirapine and six weeks of infant nevirapine. After 12 months, infants in the extended nevirapine group had a lower risk of infant mortality compared with the control. There was no difference in the risk of HIV infection or death or in HIV transmission alone in the extended nevirapine group compared with the control. Evidence quality for outcomes in this trial was generally low to moderate.One trial compared single dose nevirapine plus one week zidovudine; the control regimen plus nevirapine up to 14 weeks; or the control regimen with dual prophylaxis up to 14 weeks. At 24 months, the extended nevirapine regimen group had a lower risk of HIV transmission and of HIV transmission or death vs. the control. There was no difference in infant mortality alone. Compared with controls, the dual prophylaxis group had a lower risk of HIV transmission and of HIV transmission or death, but no difference in infant mortality alone. There was no difference in these outcomes between the two intervention arms. Evidence quality for outcomes in this trial was generally moderate to high.One trial compared six weeks of nevirapine with six months of nevirapine. Among infants of mothers not using highly active antiretroviral therapy, there was no difference in risk of HIV infection among the six month nevirapine group versus the six week nevirapine group. Evidence quality for outcomes in this trial was generally low to moderate.One trial compared a maternal triple-drug antiretroviral regimen, infant nevirapine, or neither intervention. Infants in the maternal prophylaxis arm were at lower risk for HIV, and HIV infection or death when compared with the control group. There was no difference in the risk of infant mortality alone. Infants with extended prophylaxis had a lower risk of HIV infection and of HIV infection or death versus the control group infants. There was no difference in the risk of infant mortality alone in the extended infant nevirapine group versus the control. There was no difference in HIV infection, infant mortality, and HIV infection or death between the maternal and extended infant prophylaxis groups. Evidence quality for outcomes in this trial was generally low to moderate. AUTHORS' CONCLUSIONS Antiretroviral prophylaxis, whether used by the HIV-infected mother or the HIV-exposed infant while breastfeeding, is efficacious in preventing mother-to-child transmission of HIV. Further research is needed regarding maternal resistance and response to subsequent antiretroviral therapy after maternal prophylaxis. An ongoing trial (IMPAACT 1077BF) compares the efficacy and safety of maternal triple antiretroviral prophylaxis versus daily infant nevirapine for prevention of mother-to-child transmission through breastfeeding.
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Affiliation(s)
- Angela B White
- University of California, San FranciscoGlobal Health Sciences50 Beale St.12th FloorSan FranciscoCaliforniaUSA94105
| | - Joy F Mirjahangir
- University of California, San FranciscoGlobal Health Sciences50 Beale St.12th FloorSan FranciscoCaliforniaUSA94105
| | - Hacsi Horvath
- University of California, San FranciscoGlobal Health Sciences50 Beale St.12th FloorSan FranciscoCaliforniaUSA94105
| | - Andrew Anglemyer
- University of California, San FranciscoGlobal Health Sciences50 Beale St.12th FloorSan FranciscoCaliforniaUSA94105
| | - Jennifer S. Read
- University of California, San FranciscoGlobal Health Sciences50 Beale St.12th FloorSan FranciscoCaliforniaUSA94105
- National Institutes of HealthNational Institute of Allergy and Infectious DiseasesBethesdaMarylandUSA
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Effects of postnatal interventions for the reduction of vertical HIV transmission on infant growth and non-HIV infections: a systematic review. J Int AIDS Soc 2013; 16:18865. [PMID: 24369738 PMCID: PMC3871831 DOI: 10.7448/ias.16.1.18865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 11/02/2013] [Accepted: 11/27/2013] [Indexed: 01/10/2023] Open
Abstract
Introduction Guidelines in resource-poor settings have progressively included interventions to reduce postnatal HIV transmission through breast milk. In addition to HIV-free survival, infant growth and non-HIV infections should be considered. Determining the effect of these interventions on infant growth and non-HIV infections will inform healthcare decisions about feeding HIV-exposed infants. We synthesize findings from studies comparing breast to formula feeding, early weaning to standard-duration breastfeeding, breastfeeding with extended antiretroviral (ARV) to short-course ARV prophylaxis, and alternative preparations of infant formula to standard formula in HIV-exposed infants, focusing on infant growth and non-HIV infectious morbidity outcomes. The review objectives were to collate and appraise evidence of interventions to reduce postnatal vertical HIV transmission, and to estimate their effect on growth and non-HIV infections from birth to two years of age among HIV-exposed infants. Methods We searched PubMed, SCOPUS, and Cochrane CENTRAL Controlled Trials Register. We included randomized trials and prospective cohort studies. Two authors independently extracted data and evaluated risk of bias. Rate ratios and mean differences were used as effect measures for dichotomous and continuous outcomes, respectively. Where pooling was possible, we used fixed-effects meta-analysis to pool results across studies. Quality of evidence was assessed using the GRADE approach. Results and discussion Prospective cohort studies comparing breast- versus formula-fed HIV-exposed infants found breastfeeding to be protective against diarrhoea in early life [risk ratio (RR)=0.31; 95% confidence interval (CI)=0.13 to 0.74]. The effect of breastfeeding against diarrhoea [hazard ratio (HR)=0.74; 95% CI=0.57 to 0.97] and respiratory infections (HR=0.65; 95% CI=0.41 to 1.00) was significant through two years of age. The only randomized controlled trial (RCT) available showed that breastfeeding tended to be protective against malnutrition (RR=0.63; 95% CI=0.36 to 1.12). We found no statistically significant differences in the rates of non-HIV infections or malnutrition between breast-fed infants in the extended and short-course ARV prophylaxis groups. Conclusions Low to moderate quality evidence suggests breastfeeding may improve growth and non-HIV infection outcomes of HIV-exposed infants. Extended ARV prophylaxis does not appear to increase the risk for HIV-exposed infants for adverse growth or non-HIV infections compared to short-course ARV prophylaxis.
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Gerrard SE, Larson AM, Klibanov AM, Slater NK, Hanson CV, Abrams BF, Morris MK. Reducing infectivity of HIV upon exposure to surfaces coated withN,N-dodecyl, methyl-polyethylenimine. Biotechnol Bioeng 2013; 110:2058-62. [DOI: 10.1002/bit.24867] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/31/2013] [Accepted: 02/06/2013] [Indexed: 11/10/2022]
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Abstract
This article reviews risks of illness or exposures to breastfed infants. Galactosemia in an infant is a contraindication to breastfeeding. There are no medical conditions in the mother that are contraindications, although diagnostic procedures, treatment, or illness can interfere. Restrictive diets or malnutrition are not contraindications but are opportunities to provide nutritional counseling. Environmental toxic exposures within the United States are uncommon; breastfeeding is not usually contraindicated. In any concerning situation, an assessment and discussion of risks and benefits for the mother-infant dyad (breastfed or formula fed) is indicated. Coordinated medical care and lactation assistance can facilitate successful breastfeeding.
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