1
|
Ruel T, Penazzato M, Zech JM, Archary M, Cressey TR, Goga A, Harwell J, Landovitz RJ, Lain MG, Lallemant M, Namusoke-Magongo E, Mukui I, Permar SR, Prendergast AJ, Shapiro R, Abrams EJ. Novel Approaches to Postnatal Prophylaxis to Eliminate Vertical Transmission of HIV. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200401. [PMID: 37116934 PMCID: PMC10141432 DOI: 10.9745/ghsp-d-22-00401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
Despite progress in providing antiretroviral therapy to pregnant women living with HIV, a substantial number of vertical transmissions continue to occur. Novel approaches leveraging modern potent, safe, and well-tolerated antiretroviral drugs are urgently needed.
Collapse
Affiliation(s)
- Theodore Ruel
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Jennifer M. Zech
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, NY, USA
| | | | - Tim R. Cressey
- AMS-IRD Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Ameena Goga
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, South Africa
| | | | - Raphael J. Landovitz
- UCLA Center for Clinical AIDS Research and Education, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Marc Lallemant
- AMS-PHPT Research Collaboration, Chiang Mai University, Chiang Mia, Thailand
- Penta Foundation Italy, Padova, Italy
| | | | - Irene Mukui
- Drugs for Neglected Diseases Initiative, Nairobi, Kenya
| | - Sallie R. Permar
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Andrew J. Prendergast
- Queen Mary University of London, London, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Roger Shapiro
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, NY, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
2
|
Cardenas MC, Farnan S, Hamel BL, Mejia Plazas MC, Sintim-Aboagye E, Littlefield DR, Behl S, Punia S, Enninga EAL, Johnson E, Temesgen Z, Theiler R, Gray CM, Chakraborty R. Prevention of the Vertical Transmission of HIV; A Recap of the Journey so Far. Viruses 2023; 15:v15040849. [PMID: 37112830 PMCID: PMC10142818 DOI: 10.3390/v15040849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
In 1989, one in four (25%) infants born to women living with HIV were infected; by the age of 2 years, there was 25% mortality among them due to HIV. These and other pieces of data prompted the development of interventions to offset vertical transmission, including the landmark Pediatric AIDS Clinical Trial Group Study (PACTG 076) in 1994. This study reported a 67.5% reduction in perinatal HIV transmission with prophylactic antenatal, intrapartum, and postnatal zidovudine. Numerous studies since then have provided compelling evidence to further optimize interventions, such that annual transmission rates of 0% are now reported by many health departments in the US and elimination has been validated in several countries around the world. Despite this success, the elimination of HIV’s vertical transmission on the global scale remains a work in progress, limited by socioeconomic factors such as the prohibitive cost of antiretrovirals. Here, we review some of the key trials underpinning the development of guidelines in the US as well as globally, and discuss the evidence through a historic lens.
Collapse
Affiliation(s)
- Maria Camila Cardenas
- Pediatric Residency Program, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sheila Farnan
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin L. Hamel
- Pediatric Residency Program, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Maria Camila Mejia Plazas
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Pediatric Residency Program, Nicklaus Children’s Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA
| | - Elise Sintim-Aboagye
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Dawn R. Littlefield
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Supriya Behl
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sohan Punia
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Elizabeth Ann L Enninga
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 33155, USA
| | - Erica Johnson
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Zelalem Temesgen
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Regan Theiler
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 33155, USA
| | - Clive M. Gray
- Division of Molecular Biology and Human Genetics, Biomedical Research Institute, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7600, South Africa
| | - Rana Chakraborty
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +1-507-293-9531
| |
Collapse
|
3
|
Getaneh T, Dessie G, Desta M, Assemie MA, Alemu AA, Mihiret GT, Wondmu KS, Negesse A. Early diagnosis, vertical transmission of HIV and its associated factors among exposed infants after implementation of the Option B+ regime in Ethiopia: a systematic review and meta-analysis. IJID REGIONS 2022; 4:66-74. [PMID: 35813560 PMCID: PMC9256659 DOI: 10.1016/j.ijregi.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 10/29/2022]
|
4
|
Haddad A, Voth B, Brooks J, Swang M, Carryl H, Algarzae N, Taylor S, Parker C, Van Rompay KKA, De Paris K, Burke MW. Reduced neuronal population in the dorsolateral prefrontal cortex in infant macaques infected with simian immunodeficiency virus (SIV). J Neurovirol 2021; 27:923-935. [PMID: 34554407 PMCID: PMC8901521 DOI: 10.1007/s13365-021-01019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
Pediatric HIV infection remains a global health crisis with an estimated 150,000 new mother-to-child (MTCT) infections each year. Antiretroviral therapy (ART) has improved childhood survival, but only an estimated 53% of children worldwide have access to treatment. Adding to the health crisis is the neurological impact of HIV on the developing brain, in particular cognitive and executive function, which persists even when ART is available. Imaging studies suggest structural, connectivity, and functional alterations in perinatally HIV-infected youth. However, the paucity of histological data limits our ability to identify specific cortical regions that may underlie the clinical manifestations. Utilizing the pediatric simian immunodeficiency virus (SIV) infection model in infant macaques, we have previously shown that early-life SIV infection depletes the neuronal population in the hippocampus. Here, we expand on these previous studies to investigate the dorsolateral prefrontal cortex (dlPFC). A total of 11 ART-naïve infant rhesus macaques (Macaca mulatta) from previous studies were retrospectively analyzed. Infant macaques were either intravenously (IV) inoculated with highly virulent SIVmac251 at ~1 week of age and monitored for 6-10 weeks or orally challenged with SIVmac251 from week 9 of age onwards with a monitoring period of 10-23 weeks post-infection (19-34 weeks of age), and SIV-uninfected controls were euthanized at 16-17 weeks of age. Both SIV-infected groups show a significant loss of neurons along with evidence of ongoing neuronal death. Oral- and IV-infected animals showed a similar neuronal loss which was negatively correlated to chronic viremia levels as assessed by an area under the curve (AUC) analysis. The loss of dlPFC neurons may contribute to the rapid neurocognitive decline associated with pediatric HIV infection.
Collapse
Affiliation(s)
- Alexandra Haddad
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Brittany Voth
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Janiya Brooks
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Melanie Swang
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Heather Carryl
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Norah Algarzae
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
- King Saudi University, Riyadh, Riyadh, Kingdom of Saudi Arabia
| | - Shane Taylor
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Camryn Parker
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA
| | - Koen K A Van Rompay
- California National Primate Research Center, University of California Davis, Davis, CA, 95616, USA
| | - Kristina De Paris
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Mark W Burke
- Department of Physiology and Biophysics, Howard University, Washington, DC, 20059, USA.
| |
Collapse
|
5
|
Iliyasu Z, Galadanci HS, Hassan-Hanga F, Abdulrahman Z, Tsiga FI, Marryshow SE, Aliyu MH. Healthcare Workers' Knowledge of HIV-Exposed Infant Feeding Options and Infant Feeding Counseling Practice in Northern Nigeria. Curr HIV Res 2021; 18:29-40. [PMID: 31870269 DOI: 10.2174/1570162x18666191223114657] [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: 10/29/2019] [Revised: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the existence of evidence-based HIV-exposed infant feeding guidelines, infants in Africa still acquire HIV through inappropriate feeding practices. OBJECTIVE To identify predictors of HIV-exposed infant feeding knowledge and counseling practice among health care workers (HCW) in Nigeria. METHODS Structured, pretested questionnaires were administered to HCW (n=262) in a tertiary health facility in Kano, Nigeria. Multivariate logistic regression was used to determine predictors of HIV-exposed infant feeding knowledge and counseling practice. RESULTS Of 262 respondents, (58.0%, n=152) had good knowledge of recommended feeding options. Respondents listed exclusive breastfeeding (57.6%, n=151), human milk substitutes (45.4%, n=119), HIV-negative wet-nursing (37.0%, n=97), heated expressed human milk (20.6%, n=54) and mixed feeding (13.4%, n=35) as appropriate feeding choices. Over half (57.3%, n=150) of the respondents have ever counseled a HIV-positive mother on infant feeding. Knowledge was predicted by female sex (Adjusted Odds Ratio (AOR)=2.47, 95% Confidence Interval (CI):1.35-4.52), profession (physician vs. laboratory scientist, AOR=4.00, 95%CI:1.25-12.87; nurse/midwife vs. laboratory scientist, AOR=2.75, 95%CI:1.17-9.28), infant feeding counseling training (AOR=3.27, 95%CI:1.87-5.71), and number of children (2-4 vs. 0, AOR=1.75, 95%CI:1.23-3.92). Infant feeding counseling was predicted by female sex (AOR=2.85, 95%CI:1.39-5.85), age (>40 vs. <30 years, AOR=3.87, 95%CI:1.27-15.65), knowledge of infant feeding options (good vs. fair/poor, AOR=3.96, 95%CI:2.07-7.59), training (AOR=2.60, 95%CI:1.42-5.32), and profession (physician vs. laboratory scientist, AOR=10.7, 95%CI:2.85-40.54; nurse/midwife vs. laboratory scientist, AOR=4.8, 95%CI:1.26-18.02). CONCLUSION The practice of infant feeding counseling among HCW in Nigeria is associated with sex, knowledge, and profession. Our findings may inform the development of targeted training programs for HCW in similar settings.
Collapse
Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Kano, Nigeria.,Centre for Infectious Diseases Research, Bayero University Kano, Nigeria
| | - Hadiza S Galadanci
- Department of Obstetrics and Gynecology, Bayero University, Kano, Nigeria
| | | | | | | | - Salisha E Marryshow
- Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Tennessee, United States
| | - Muktar H Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Tennessee, United States
| |
Collapse
|
6
|
Bhatta M, Dutta N, Nandi S, Dutta S, Saha MK. Mother-to-child HIV transmission and its correlates in India: systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:509. [PMID: 32887567 PMCID: PMC7473816 DOI: 10.1186/s12884-020-03193-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/19/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In India, preventing mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) remains one of the foremost challenge in community health. Countrywide MTCT of HIV is estimated to be > 10,000 annually. Aims of present study are to find out the prevalence of HIV and correlates of HIV transmission among children given birth by HIV infected mother through systematic review along with meta-analysis. METHODS All avaiable articles are retrieved using MEDLINE, Cochrane Library, Science Direct, EMBASE, Google Scholar and PUBMED following guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) are applied to critically reviewing the selected articles. STATA 13.0 is used to preparation of forest plot for Meta-analysis. For assessment of heterogeneity and publication biases I2 statistics along with Begg and Mazumdar's test and Egger's tests are used. Odds ratio (OR) along with forest plots have been showing with 95% confidence interval (CI). RESULTS All together 10 studies including 1537 pairs of mothers and new births are assessed in present meta-analysis. Present analysis revealed the prevalence of HIV due to MTCT in India as 8.76% (95% CI; 5.76, 12.31). Analysis of subgroups exhibit a higher pooled prevalence in eastern region of India, 10.83% (95% CI: 5.9, 17.81) and lower in in Western region in India, 6.37% (95% CI: 4.65, 8.49). Status of MTCT before and after initiation of universal ART are 10.23% (95% CI 6.61, 14.55) and 7.93% (95% CI 4.18, 12.76) respectively. Associated factors with MTCT of HIV include absence of maternal prevention of MTCT intervention, OR = 10.82 (95% CI: 5.28, 22.17), lacking in administration of infant ARV (antiretroviral), OR = 8.21 (95% CI: 4.82, 14.0) and absence of medical facility during childbirth OR = 3.73 (95% CI: 1.67, 8.33). CONCLUSIONS In India, pooled HIV prevalence of MTCT as high as 8.78% (95% CI; 5.76, 12.31) among babies born to infected mothers warrants urgent need of focused intervention for providing ART (PMTCT intervention), ensuring proper infant ARV prophylaxis, and avoiding delivery without proper medical facility to pregnant women with HIV for reduction of occurrence in HIV transmission from mothers to children.
Collapse
Affiliation(s)
- Mihir Bhatta
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Nalok Dutta
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Srijita Nandi
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Shanta Dutta
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Malay Kumar Saha
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| |
Collapse
|
7
|
Freeman-Romilly N, Nyatsanza F, Namiba A, Lyall H. Moving closer to what women want? A review of breastfeeding and women living with HIV in the UK and high-income countries. HIV Med 2020; 21:1-8. [PMID: 31825556 DOI: 10.1111/hiv.12792] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | - F Nyatsanza
- ICASH Cambridgeshire, Cambridge Community Services NHS Trust, GUM/HIV, Cambridge, UK
| | | | - H Lyall
- Imperial College Healthcare NHS Trust, Children's Services, London, UK
| |
Collapse
|
8
|
Njom Nlend AE, Nguedou Marcelle K, Koki Ndombo P, Brunelle Sandié A. [12-months efficacy of option B+ for prevention of mother-to-child transmission of HIV in Yaoundé, Cameroon]. Rev Epidemiol Sante Publique 2019; 67:163-167. [PMID: 30992178 DOI: 10.1016/j.respe.2019.03.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 09/04/2018] [Accepted: 03/14/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Cameroon has adopted the option B+ for the prevention of mother-to-child transmission (MTCT) program of HIV in August 2014 in order to eradicate MTCT of HIV. OBJECTIVE To analyze in routine life settings, efficacy of option B+ for PMTCT and associate factors. METHODS We conducted a cross-sectional study over a 6-month period in the ESSOS hospital center. Study population comprised HIV-positive mothers and their infants aged 0-24 months. Variables included were : moment of HIV maternal testing, timing of commencement of maternal antiretroviral therapy (ART) and self-reported adherence to ART. Efficacy was measured through early and late MTCT rate and associated factors. RESULTS We included 200 mothers and 124 infants. Under option B+, the rate of transmission was at 4.20% at 6 weeks and 5.83% at 12 months. The rate of HIV transmission in breastfed infants stood at 3.7%. In unadjusted analysis, bottle-feeding, term at birth, early screening and management during pregnancy were associated with lower risk of HIV transmission. After adjustment, term at delivery after 37 weeks adjusted odds ratio (AOR) [0.059; (0.0061; 0.56)] was protective; while lack of prophylaxis was among HIV-exposed infants emerged as the main factor associated with residual transmission of HIV [AOR 117.23 ; (3.55 ; 3874.9)]. CONCLUSION In this setting of Yaoundé, routine option B+ posted laudable results at 12 months even amongst breastfed children and should therefore be made sustainable.
Collapse
Affiliation(s)
- A E Njom Nlend
- Centre hospitalier d'ESSOS, caisse nationale de prévoyance sociale, Yaoundé, Cameroun; Institut de technologies médicales Nkolondom, université de Douala, Yaoundé, Cameroun.
| | - K Nguedou Marcelle
- Institut de technologies médicales Nkolondom, université de Douala, Yaoundé, Cameroun
| | - P Koki Ndombo
- Faculté de médecine et de sciences biomédicales, université de Yaoundé, Cameroun; Centre mère-enfant fondation Chantal-Biya, Yaoundé, Cameroun
| | - A Brunelle Sandié
- Département de statistiques, université panafricaine de Nairobi, Nairobi, Kenya
| |
Collapse
|
9
|
Marotta C, Di Gennaro F, Pizzol D, Madeira G, Monno L, Saracino A, Putoto G, Casuccio A, Mazzucco W. The At Risk Child Clinic (ARCC): 3 Years of Health Activities in Support of the Most Vulnerable Children in Beira, Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071350. [PMID: 29954117 PMCID: PMC6069480 DOI: 10.3390/ijerph15071350] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 01/08/2023]
Abstract
The concept of “children at risk” changes worldwide according to each specific context. Africa has a large burden of overall risk factors related to childhood health and development, most of which are of an infective or social origin. The aim of this study was to report and analyze the volumes of activities of fifteen At Risk Child Clinics (ARCCs) within the Beira District (Mozambique) over a 3 year-period in order to define the health profile of children accessing such health services. We retrospectively analyzed the data from all of the children accessing one of the 15 Beira ARCCs from January 2015 to December 2017. From this, 17,657 first consultations were registered. The motivations for accessing the services were in order of relevance: HIV exposure (n. 12,300; 69.7%), other risk conditions (n. 2542; 14.4%), Moderate Acute Malnutrition (MAM) (n. 1664; 9.4%), Severe Acute Malnutrition (SAM) (n. 772; 4.4%), and TB exposure (n. 542; 3.1%). During the first consultations, 16,865 children were screened for HIV (95.5%), and 7.89% tested HIV-positive. In our three years of experience, HIV exposure was the main indication for children to access the ARCCs in Mozambique. ARCCs could represent a strategic point to better understand health demands and to monitor the quality of care provided to this vulnerable population group, however significant effort is needed to improve the quality of the data collection.
Collapse
Affiliation(s)
- Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
| | - Francesco Di Gennaro
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
- Research Unit, Doctors with Africa CUAMM, Beira 1363, Mozambique.
| | - Damiano Pizzol
- Research Unit, Doctors with Africa CUAMM, Beira 1363, Mozambique.
| | | | - Laura Monno
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Annalisa Saracino
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Giovanni Putoto
- Research Section, Doctors with Africa CUAMM, Padova 35128, Italy.
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
| | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
| |
Collapse
|
10
|
Kassa GM. Mother-to-child transmission of HIV infection and its associated factors in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2018; 18:216. [PMID: 29747581 PMCID: PMC5946547 DOI: 10.1186/s12879-018-3126-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 05/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mother-to-child transmission (MTCT) is the main mode of HIV transmission in children under 15 years old. This problem is significant in the Sub-Saharan African countries, where more than 80% of children living with HIV are found. Previous studies in Ethiopia present inconsistent and inconclusive findings on the prevalence and associated factors of MTCT of HIV. Therefore, this study was conducted to determine the pooled prevalence of MTCT of HIV and its associated factors in Ethiopia. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. All published studies were retrieved using relevant search terms in MEDLINE, PUBMED, Cochrane Library, EMBASE, Google Scholar, CINAHL, and African Journals Online databases. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to critically appraise articles. STATA version 14 software was used to perform the Meta-analysis. The I2 statistics was used to test heterogeneity and publication bias was assessed using Begg’s and Egger’s tests. Odds ratio (OR) with 95% confidence interval (CI) was presented using forest plots. Results A total of nine studies, 3688 mother-baby pairs, were included in this meta-analysis. The pooled prevalence of MTCT of HIV in Ethiopia was 9.93% (95% CI: 7.29, 12.56). The subgroup analysis showed a higher prevalence of MTCT of HIV in Dire Dawa City Administration (15.7%) and lowest in Southern Nations, Nationality and Peoples Region (SNNPR) (4.16%). Associated factors with MTCT of HIV include: mixed feeding, OR = 7.46 (95%CI: 4.71, 11.81), absence of infant ARV prophylaxis, OR = 7.89 (95%CI: 4.32, 14.42), home delivery, OR = 5.08 (95%CI: 2.32, 11.15), and absence of maternal PMTCT intervention, OR = 7.13 (95% CI: 3.31, 15.35). Conclusions Almost one in ten HIV exposed infants become HIV positive in Ethiopia. Factors like: mixed feeding, the absence of infant ARV prophylaxis, home delivery and absence of mother’s PMTCT intervention were significantly associated with MTCT of HIV. Therefore, the governmental and non-governmental organizations need to focus on the identified factors and work towards improving the prevention of mother to child transmission of HIV (PMTCT) program.
Collapse
|
11
|
Lang'at PC, Ogada I, Steenbeek A, MacDonald NE, Ochola S, Bor W, Odinga G. Infant feeding practices among HIV-exposed infants less than 6 months of age in Bomet County, Kenya: an in-depth qualitative study of feeding choices. Arch Dis Child 2018; 103:470-473. [PMID: 29317437 DOI: 10.1136/archdischild-2017-314521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND In children, HIV can be acquired from the mother during pregnancy, delivery and through breast milk. The WHO recommends exclusive breast feeding or exclusive replacement feeding for the first 6 months after birth for HIV-exposed infants. Barriers such as HIV-related stigma, inadequate resources, lack of access to safe water and negative cultural beliefs have been shown to influence infant feeding among HIV-exposed infants in some settings. In Kenya, there is limited literature on the barriers. The purpose of this study was to identify barriers to optimal feeding among HIV-exposed infants 0-5 months of age attending a mission hospital in Bomet County, Kenya. METHODS A cross-sectional qualitative study was conducted at a referral mission hospital in Bomet County, Southwest Kenya. Four focused group discussions were conducted among mothers/caregivers of HIV-exposed infants aged 0-5 months in accordance with their infant feeding practices, while two key informant interviews were also held with healthcare workers. All sessions were audio recorded and later transcribed verbatim. Content analysis was performed, and conclusions were made based on identified themes. RESULTS Factors influencing the infant feeding choices were: financial constraints, cultural beliefs and practices, HIV-related stigma and conflicting knowledge among mothers/caregivers and healthcare workers on the recommendations for feeding HIV-exposed infants 0-5 months of age. CONCLUSIONS Health worker retraining in and reinforcement of WHO guidance on feeding HIV exposed/infected infants will clarify misconceptions around feeding HIV exposed/infected infants, though there remain social and economic barriers to full implementation.
Collapse
Affiliation(s)
- Purity Chepkorir Lang'at
- Department of Food, Nutrition and Dietetics, School of Applied Human Sciences, Kenyatta University, Nairobi, Kenya.,Department of Human Nutrition and Dietetics, School of Medicine and Health sciences, Kabarak University, Nakuru, Kenya
| | - Irene Ogada
- Department of Food, Nutrition and Dietetics, School of Applied Human Sciences, Kenyatta University, Nairobi, Kenya
| | - Audrey Steenbeek
- Department of Community Health and Epidemiology, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Noni E MacDonald
- Department of Paediatrics, Faculty of Medicine, MicroResearch International, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sophie Ochola
- Department of Food, Nutrition and Dietetics, School of Applied Human Sciences, Kenyatta University, Nairobi, Kenya
| | - Wesley Bor
- Department of Human Nutrition and Dietetics, School of Medicine and Health sciences, Kabarak University, Nakuru, Kenya
| | - Godfrey Odinga
- Department of Tourism Management, School of Tourism, Hospitality and Events Management, Moi University, Eldoret, Kenya
| |
Collapse
|
12
|
Postnatal HIV transmission in breastfed infants of HIV-infected women on ART: a systematic review and meta-analysis. J Int AIDS Soc 2017; 20:21251. [PMID: 28362072 PMCID: PMC5467610 DOI: 10.7448/ias.20.1.21251] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: To systematically review the literature on mother-to-child transmission in breastfed infants whose mothers received antiretroviral therapy and support the process of updating the World Health Organization infant feeding guidelines in the context of HIV and ART. Methods: We reviewed experimental and observational studies; exposure was maternal HIV antiretroviral therapy (and duration) and infant feeding modality; outcomes were overall and postnatal HIV transmission rates in the infant at 6, 9, 12 and 18 months. English literature from 2005 to 2015 was systematically searched in multiple electronic databases. Papers were analysed by narrative synthesis; data were pooled in random effects meta-analyses. Postnatal transmission was assessed from four to six weeks of life. Study quality was assessed using a modified Newcastle-Ottawa Scale (NOS) and GRADE. Results and discussion: Eleven studies were identified, from 1439 citations and review of 72 abstracts. Heterogeneity in study methodology and pooled estimates was considerable. Overall pooled transmission rates at 6 months for breastfed infants with mothers on antiretroviral treatment (ART) was 3.54% (95% CI: 1.15–5.93%) and at 12 months 4.23% (95% CI: 2.97–5.49%). Postnatal transmission rates were 1.08 (95% CI: 0.32–1.85) at six and 2.93 (95% CI: 0.68–5.18) at 12 months. ART was mostly provided for PMTCT only and did not continue beyond six months postpartum. No study provided data on mixed feeding and transmission risk. Conclusions: There is evidence of substantially reduced postnatal HIV transmission risk under the cover of maternal ART. However, transmission risk increased once PMTCT ART stopped at six months, which supports the current World Health Organization recommendations of life-long ART for all.
Collapse
|
13
|
Mwau M, Bwana P, Kithinji L, Ogollah F, Ochieng S, Akinyi C, Adhiambo M, Ogumbo F, Sirengo M, Boeke C. Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years. PLoS One 2017; 12:e0183860. [PMID: 28850581 PMCID: PMC5574578 DOI: 10.1371/journal.pone.0183860] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 08/11/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage. Design Cross-sectional analysis of national early infant diagnosis (EID) database. Methods 365,841 Kenyan infants were tested for HIV from January 2007-July 2015 and results, demographics, and treatment information were entered into a national database. HIV risk factors were assessed using multivariable logistic regression. Results 11.1% of infants tested HIV positive in 2007–2010 and 6.9% in 2014–2015. Greater odds of infection were observed in females (OR: 1.08; 95% CI:1.05–1.11), older children (18–24 months vs. 6 weeks-2 months: 4.26; 95% CI:3.87–4.69), infants whose mothers received no PMTCT intervention (vs. HAART OR: 1.92; 95% CI:1.79–2.06), infants receiving no prophylaxis (vs. nevirapine for 6 weeks OR: 2.76; 95% CI:2.51–3.05), and infants mixed breastfed (vs. exclusive breastfeeding OR: 1.39; 95% CI:1.30–1.49). In 2014–2015, 9.1% of infants had mothers who were not on treatment during pregnancy, 9.8% were not on prophylaxis, and 7.0% were mixed breastfed. Infants exposed to all three risky practices had a seven-fold higher odds of HIV infection compared to those exposed to recommended practices. The highest yield of HIV-positive infants were found through targeted testing of symptomatic infants in pediatric/outpatient departments (>15%); still, most infected infants were identified through PMTCT programs. Conclusion Despite impressive gains in Kenya’s PMTCT program, some HIV-infected infants present late and are not benefitting from PMTCT best practices. Efforts to identify these early and enforce evidence-based practice for PMTCT should be scaled up. Infant testing should be expanded in pediatric/outpatient departments, given high yields in these portals.
Collapse
Affiliation(s)
- Matilu Mwau
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
- * E-mail:
| | - Priska Bwana
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lucy Kithinji
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Francis Ogollah
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Samuel Ochieng
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Catherine Akinyi
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Maureen Adhiambo
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Fred Ogumbo
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Martin Sirengo
- National AIDS and STIs Control Program, Ministry of Health, Nairobi, Kenya
| | - Caroline Boeke
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| |
Collapse
|
14
|
Somé EN, Engebretsen IMS, Nagot N, Meda N, Lombard C, Vallo R, Peries M, Kankasa C, Tumwine JK, Hofmeyr GJ, Singata M, Harper K, Van De Perre P, Tylleskar T. Breastfeeding patterns and its determinants among mothers living with Human Immuno-deficiency Virus -1 in four African countries participating in the ANRS 12174 trial. Int Breastfeed J 2017; 12:22. [PMID: 28469697 PMCID: PMC5414228 DOI: 10.1186/s13006-017-0112-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/10/2017] [Indexed: 11/20/2023] Open
Abstract
Background HIV-1 transmission rates have been reduced over the last decade, an estimated 2 million new infections per year arise, including 220,000 paediatric cases. The main post-natal HIV exposure is through breastfeeding, where both its duration and modality (exclusive or not) are associated with postnatal transmission. The ANRS 12174 trial compared HIV-1 postnatal transmission of 2 prophylaxis drugs for infants during lactation (lamivudine and lopinavir-ritonavir). Our objective has been to examine the feeding practices and the determinants of exclusive/ predominant (EPBF) or any breastfeeding among the participants of this trial in Burkina Faso, South Africa, Uganda and Zambia. Methods Mothers infected with HIV-1 and their uninfected offspring were followed from day 7 after birth for 50 weeks, keeping monthly records of their feeding patterns. Feeding was classified into 3 categories: 1) exclusive breastfeeding during the first six months, only breast-milk being given to infant for 6 months, 2) predominant breastfeeding, breast-milk with liquid-based items being given, and 3) mixed feeding, other non-breast milk or solid food being given in addition to breast milk with or without liquid-based items. The categories were merged into 2 groups: EPBF applying to infants aged <6 months and mixed feeding applying to infants of any age. The feeding patterns have been given as Kaplan-Meier curves. A flexible parametric multiple regression model was used to identify the determinants of the mothers’ feeding behaviour. Results A total of 1,225 mother-infant pairs provided feeding data from Burkina Faso (N = 204), South Africa (N = 213), Uganda (N = 274) and Zambia (N = 534) between November 2009 and March 2013. The mean maternal age was 27.4 years and the mean BMI was 24.5. 57.7 and 93.9% of mothers initiated breastfeeding within the first hour and first day, respectively. Overall, the median durations of any form of breastfeeding and EPBF were 40.6, and 20.9 weeks, respectively. Babies randomized to the lopinavir/ritonavir group in South Africa tended to do less EPBF than those in the lamivudine group. Overall the group of mothers aged between 25 and 30 years, those married, employed or multiparous tended to stop early EPBF. Mothers living in Uganda or Zambia, those aged between 25 -30 years, better educated (at least secondary school level), employed or having undergone C-section stopped any breastfeeding early. Conclusions There is a need to improve breastfeeding and complementary feeding practices of children, particularly those exposed to HIV and anti-retrovirals, taking into account context and socio-demographic factors. Trial registration Clinical trial registration: NCT00640263. Electronic supplementary material The online version of this article (doi:10.1186/s13006-017-0112-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eric N Somé
- Centre for International Health, University of Bergen, Bergen, Norway.,National Health Research Institute, Centre National pour la Recherche Scientifique et Technologique, 10 BP 250 Ouagadougou, Burkina Faso
| | | | - Nicolas Nagot
- INSERM UMR 1058, Pathogenesis and control of chronic infections, Montpellier, France.,Université de Montpellier, Montpellier, France.,Centre Hospitalier Universitaire, Montpellier, France
| | - Nicolas Meda
- Faculty of Health Sciences, Centre de Recherche International en Santé (CRIS), University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Carl Lombard
- South African Medical Research Council, Biostatistics Unit, Cape Town, South Africa
| | - Roselyne Vallo
- INSERM UMR 1058, Pathogenesis and control of chronic infections, Montpellier, France.,Université de Montpellier, Montpellier, France
| | - Marianne Peries
- INSERM UMR 1058, Pathogenesis and control of chronic infections, Montpellier, France.,Université de Montpellier, Montpellier, France
| | - Chipepo Kankasa
- Department of Paediatrics and Child Health, University of Zambia, School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - James K Tumwine
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, School of Medicine, Kampala, Uganda
| | - G Justus Hofmeyr
- Effective Care Research Unit, University of Fort Hare, Eastern Cape, South Africa
| | - Mandisa Singata
- Effective Care Research Unit, University of Fort Hare, Eastern Cape, South Africa
| | - Kim Harper
- Effective Care Research Unit, University of Fort Hare, Eastern Cape, South Africa
| | - Philippe Van De Perre
- INSERM UMR 1058, Pathogenesis and control of chronic infections, Montpellier, France.,Université de Montpellier, Montpellier, France.,Centre Hospitalier Universitaire, Montpellier, France
| | | | | |
Collapse
|
15
|
Carryl H, Van Rompay KKA, De Paris K, Burke MW. Hippocampal Neuronal Loss in Infant Macaques Orally Infected with Virulent Simian Immunodeficiency Virus (SIV). Brain Sci 2017; 7:E40. [PMID: 28394273 PMCID: PMC5406697 DOI: 10.3390/brainsci7040040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/21/2022] Open
Abstract
The neurological impact of Human Immunodeficiency Virus (HIV) on children includes loss of brain growth, motor abnormalities and cognitive dysfunction. Despite early antiretroviral treatment (ART) intervention to suppress viral load, neurological consequences of perinatal HIV-1 infection persist. Utilizing the pediatric simian immunodeficiency virus (SIV) infection model, we tested the hypothesis that early-life SIV infection depletes neuronal population in the hippocampus. A total of 22 ART-naïve infant rhesus macaques (Macaca mulatta) from previous studies were retrospectively analyzed. Infant macaques were either intravenously (IV) inoculated with highly virulent SIVmac251 at ~1 week of age and monitored for 6-10 weeks, or orally challenged with SIVmac251 from week 9 of age onwards with a monitoring period of 10-23 weeks post-infection (19-34 weeks of age), and SIV-uninfected controls were euthanized at 16-17 weeks of age. We have previously reported that the IV SIVmac251-infected neonatal macaques (Group 1) displayed a 42% neuronal reduction throughout the hippocampal cornu ammonis (CA) fields. The orally-infected infant macaques displayed a 75% neuronal reduction in the CA1 region compared to controls and 54% fewer neurons than IV SIV infants. The CA2 region showed a similar pattern, with a 67% reduction between orally-infected SIV subjects and controls and a 40% difference between IV-and orally-infected SIV groups. In the CA3 region, there were no significant differences between these groups, however both SIV-infected groups had significantly fewer pyramidal neurons than control subjects. There was no correlation between plasma viral load and neuronal populations in any of the CA fields. The loss of hippocampal neurons may contribute to the rapid neurocognitive decline associated with pediatric HIV infection. While each subfield showed vulnerability to SIV infection, the CA1 and CA2 subregions demonstrated a potentially enhanced vulnerability to pediatric SIV infection. These data underscore the need for early diagnosis and treatment, including therapeutics targeting the central nervous system (CNS).
Collapse
Affiliation(s)
- Heather Carryl
- Department of Physiology and Biophysics, Howard University, Washington, DC 20059, USA.
| | - Koen K A Van Rompay
- California National Primate Research Center, University of California Davis, Davis, CA 95616, USA.
| | - Kristina De Paris
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Mark W Burke
- Department of Physiology and Biophysics, Howard University, Washington, DC 20059, USA.
| |
Collapse
|
16
|
Infant and Young Child Feeding Counseling, Decision-Making, and Practices Among HIV-Infected Women in Malawi's Option B+ Prevention of Mother-to-Child Transmission Program: A Mixed Methods Study. AIDS Behav 2016; 20:2612-2623. [PMID: 27022939 DOI: 10.1007/s10461-016-1378-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined infant and young child feeding (IYCF) counseling, decision-making, and practices among HIV-infected women with children 0-23 months participating in Malawi's Option B+ prevention of mother-to-child transmission (PMTCT) program. We conducted 160 survey interviews, 32 in-depth interviews, and 32 observations of PMTCT visits. Surveys indicated that exclusive breastfeeding was common (75 %) among children <6 months, while minimum dietary diversity (41 %) and minimum acceptable diet (40 %) for children 6-23 months occurred less often. In-depth interviews supported these findings. Most women felt comfortable with current breastfeeding recommendations, but chronic food insecurity made it difficult for them to follow complementary feeding guidelines. Women trusted IYCF advice from health workers, but mainly received it during pregnancy. During observations of postnatal PMTCT visits, health workers infrequently advised on breastfeeding (41 % of visits) or complementary feeding (29 % of visits). This represents a missed opportunity for health workers to support optimal IYCF practices within Option B+.
Collapse
|
17
|
Ngwej DT, Mukuku O, Mudekereza R, Karaj E, Odimba EBF, Luboya ON, Kakoma JBS, Wembonyama SO. [Study of risk factors for HIV transmission from mother to child in the strategy «option A» in Lubumbashi, Democratic Republic of Congo]. Pan Afr Med J 2015; 22:18. [PMID: 26600917 PMCID: PMC4646444 DOI: 10.11604/pamj.2015.22.18.7480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Olivier Mukuku
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, RD Congo
| | | | | | | | - Oscar Numbi Luboya
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, RD Congo
| | | | | |
Collapse
|
18
|
Okanda JO, Borkowf CB, Girde S, Thomas TK, Lecher SL. Exclusive breastfeeding among women taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study. BMC Pediatr 2014; 14:280. [PMID: 25380718 PMCID: PMC4326202 DOI: 10.1186/1471-2431-14-280] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 10/16/2014] [Indexed: 11/10/2022] Open
Abstract
Background One of the most effective ways to promote the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings is to encourage HIV-positive mothers to practice exclusive breastfeeding (EBF) for the first 6 months post-partum while they receive antiretroviral therapy (ARV). Although EBF reduces mortality in this context, its practice has been low. We studied the rate of adherence to EBF and assessed associated maternal and infant characteristics using data from a phase II PMTCT clinical trial conducted in Western Kenya which included a counseling intervention to encourage EBF by all participants. Methods We analyzed data from the Kisumu Breastfeeding Study (KiBS), conducted between July 2003 and February 2009. This study enrolled a total of 522 HIV-1 infected pregnant women. Data on breastfeeding were available for 480 mother-infant pairs. Infant feeding and general nutrition counseling began at 35 weeks gestation and continued throughout the 6 month post-partum intervention period, following World Health Organization (WHO) infant feeding guidelines. Data on infant feeding were collected during routine clinic visits and home visits using food frequency questionnaires and dietary recall methods. Participants were instructed to exclusively breastfeed until initiation of weaning at 5.5 months post-partum. We used Kaplan-Meier methods to estimate the rates of EBF at 5.25 months post-partum, stratified by maternal and infant characteristics measured at enrollment, delivery, and 2 weeks post-partum. Results The estimated EBF rate at 5.25 months post-partum was 80.4%. Only 3% of women introduced other foods (most commonly water with or without glucose, cow’s milk, formula, and fruit) by 2 months; this percentage increased to 5% of women by 4 months. Women who had ≥3 previous births (p < 0.01) and who were not living with the infant’s father (p = 0.04) were more likely to exclusively breastfeed. Mixed feeding was more common for male infants than for female infants (p = 0.04). Conclusion Exclusive breastfeeding was common in this clinical trial, which emphasized EBF as a best practice until infants reached 5.5 months of age. Counseling initiated prior to delivery and continued during the post-partum period provided a consistent message reinforcing the benefits of EBF. The findings from this study suggest high adherence to EBF in resource limited settings can be achieved by a comprehensive counseling intervention that encourages EBF.
Collapse
Affiliation(s)
- John O Okanda
- Kenya Medical Research Institute/U,S, Centers for Disease Control and Prevention (KEMRI/CDC), Research and Public Health Collaboration, P,O, Box 1578, 40100 Kisumu, Kenya.
| | | | | | | | | |
Collapse
|
19
|
Yu W, Li C, Fu X, Cui Z, Liu X, Fan L, Zhang G, Ma J. The cost-effectiveness of different feeding patterns combined with prompt treatments for preventing mother-to-child HIV transmission in South Africa: estimates from simulation modeling. PLoS One 2014; 9:e102872. [PMID: 25055039 PMCID: PMC4108380 DOI: 10.1371/journal.pone.0102872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 06/23/2014] [Indexed: 12/02/2022] Open
Abstract
Objectives Based on the important changes in South Africa since 2009 and the Antiretroviral Treatment Guideline 2013 recommendations, we explored the cost-effectiveness of different strategy combinations according to the South African HIV-infected mothers' prompt treatments and different feeding patterns. Study Design A decision analytic model was applied to simulate cohorts of 10,000 HIV-infected pregnant women to compare the cost-effectiveness of two different HIV strategy combinations: (1) Women were tested and treated promptly at any time during pregnancy (Promptly treated cohort). (2) Women did not get testing or treatment until after delivery and appropriate standard treatments were offered as a remedy (Remedy cohort). Replacement feeding or exclusive breastfeeding was assigned in both strategies. Outcome measures included the number of infant HIV cases averted, the cost per infant HIV case averted, and the cost per life year(LY) saved from the interventions. One-way and multivariate sensitivity analyses were performed to estimate the uncertainty ranges of all outcomes. Results The remedy strategy does not particularly cost-effective. Compared with the untreated baseline cohort which leads to 1127 infected infants, 698 (61.93%) and 110 (9.76%) of pediatric HIV cases are averted in the promptly treated cohort and remedy cohort respectively, with incremental cost-effectiveness of $68.51 and $118.33 per LY, respectively. With or without the antenatal testing and treatments, breastfeeding is less cost-effective ($193.26 per LY) than replacement feeding ($134.88 per LY), without considering the impact of willingness to pay. Conclusion Compared with the prompt treatments, remedy in labor or during the postnatal period is less cost-effective. Antenatal HIV testing and prompt treatments and avoiding breastfeeding are the best strategies. Although encouraging mothers to practice replacement feeding in South Africa is far from easy and the advantages of breastfeeding can not be ignored, we still suggest choosing replacement feeding as far as possible.
Collapse
Affiliation(s)
- Wenhua Yu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Changping Li
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaomeng Fu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhuang Cui
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaoqian Liu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Linlin Fan
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Guan Zhang
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Jun Ma
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
- * E-mail:
| |
Collapse
|
20
|
Individualizing the WHO HIV and infant feeding guidelines: optimal breastfeeding duration to maximize infant HIV-free survival. AIDS 2014; 28 Suppl 3:S287-99. [PMID: 24991902 DOI: 10.1097/qad.0000000000000337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine how infant feeding recommendations can maximize HIV-free survival (HFS) among HIV-exposed, uninfected African infants, balancing risks of breast milk-associated HIV infection with setting-specific risks of illness and death associated with replacement feeding. DESIGN Validated mathematical model of HIV-exposed, uninfected infants, with published data from Africa. METHODS We projected 24-month HFS using combinations of: maternal CD4, antiretroviral drug availability, and relative risk of mortality among replacement-fed compared to breastfed infants ('RR-RF', range 1.0-6.0). For each combination, we identified the 'optimal' breastfeeding duration (0-24 months) maximizing HFS. We compared HFS under an 'individualized' approach, based on the above parameters, to the WHO 'public health approach' (12 months breastfeeding for all HIV-infected women). RESULTS Projected HFS was 65-93%. When the value of RR-RF is 1.0, replacement feeding from birth maximized HFS. At a commonly reported RR-RF value (2.0), optimal breastfeeding duration was 3-12 months, depending on maternal CD4 and antiretroviral drug availability. As the value of RR-RF increased, optimal breastfeeding duration increased. Compared to the public health approach, an individualized approach improved absolute HFS by less than 1% if RR-RF value was 2.0-4.0, by 3% if RR-RF value was 1.0 or 6.0, and by greater amounts if access to antiretroviral drugs was limited. CONCLUSION Tailoring breastfeeding duration to maternal CD4, antiretroviral drug availability, and local replacement feeding safety can optimize HFS among HIV-exposed infants. An individualized approach leads to moderate gains in HFS, but only when mortality risks from replacement feeding are very low or very high, or antiretroviral drug availability is limited. The WHO public health approach is beneficial in most resource-limited settings.
Collapse
|
21
|
Derebe G, Biadgilign S, Trivelli M, Hundessa G, Robi ZD, Gebre-Mariam M, Makonnen M. Determinant and outcome of early diagnosis of HIV infection among HIV-exposed infants in southwest Ethiopia. BMC Res Notes 2014; 7:309. [PMID: 24885260 PMCID: PMC4045956 DOI: 10.1186/1756-0500-7-309] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preventing mother-to-child transmission (PMTCT) of human immunodeficiency virus infection (HIV) has been a fundamental advancement in the acquired immunodeficiency syndrome (AIDS) response for the past decade. Several countries have made great strides in the efforts to prevent HIV through mother-to-child transmission. The objective of this study is to assess the determinant and outcome of early diagnosis of HIV infection among HIV-exposed infants in southwest Ethiopia. METHODS An institutional based retrospective cohort study was conducted in a hospital. Medical records of HIV-exposed infants and their mothers enrolled into the program were reviewed. Data entry and analysis was carried out using SPSS version 20 for Windows. RESULTS A total of 426 HIV exposed infant-mother pairs where both mother and infants received a minimum ARV intervention for PMTCT were included in the study. Two hundred fifty-four (59.6%) of mothers had attended antenatal care (ANC). Of all participants, 234(54.9%) mothers did not receive any PMTCT prophylaxis during ANC, while only 104(24.4) received antiretroviral (ART) as PMTCT prophylaxis and 163(38.3%) claimed that did not observe any infant PMTCT interventions while 135(31.7%) of the infants received single-dose NVP + AZT. About 385(90.4%) infants were not infected at their final infection status. Those mothers who did not attended ANC follow-up, infants on mixed and complementary feeding and infants weaned off and mothers who were in WHO clinical stage III and IV were more likely to have HIV sero positive infant. CONCLUSION This study showed that 385(90.4%) of the infants were not infected at their final infection status. Therefore, encouraging pregnant women to visit health facilities during their course of pregnancy, focusing on exclusive breast feeding counseling and promotion, and early initiation of antiretroviral treatment to HIV infected pregnant women are recommend.
Collapse
Affiliation(s)
| | - Sibhatu Biadgilign
- Ethiopian Catholic Church, Health and HIV/AIDS Department, Addis Ababa, Ethiopia.
| | | | | | | | | | | |
Collapse
|
22
|
Israel-Ballard K, Waithaka M, Greiner T. Infant feeding counselling of HIV-infected women in two areas in Kenya in 2008. Int J STD AIDS 2014; 25:921-8. [PMID: 24594896 DOI: 10.1177/0956462414526574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While WHO no longer recommends individual infant feeding counselling to HIV-positive women, it may still be practised in some settings and for specific cases. In any case, lessons can be learned by examining how well front line health workers are able to take on counselling tasks. This qualitative study was designed to assess how counsellors deal with challenges they face in two Kenyan provinces. It consisted of brief post-counselling exit interviews with 80 mothers, observations of 21 counselling sessions and 11 key informant interviews. Much infant feeding counselling was of reasonable quality, better than often reported elsewhere. However, nutrition and infant feeding were given low priority, counsellors' training was inadequate, individual postnatal counselling as well as growth monitoring and promotion were rarely done and complementary feeding was inadequately covered. Acceptable, feasible, affordable, sustainable and safe (AFASS) assessments were not of satisfactory quality. Breast milk expression was mentioned only to a minority and the possibility of heat treatment during the transition to cessation was not mentioned. Counsellors were often biased in discussing risks of breastfeeding and replacement feeding. Implementing the new WHO guidance will reduce the need for AFASS assessments, greatly simplifying both the government's and counsellors' tasks.
Collapse
Affiliation(s)
| | | | - Ted Greiner
- Department of Food and Nutrition, Hanyang University, Seoul, South Korea
| |
Collapse
|
23
|
Exosomes from breast milk inhibit HIV-1 infection of dendritic cells and subsequent viral transfer to CD4+ T cells. AIDS 2014; 28:171-80. [PMID: 24413309 DOI: 10.1097/qad.0000000000000159] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether exosomes derived from human breast milk or plasma confer protection against HIV-1 infection of monocyte-derived dendritic cells (MDDCs) and subsequent viral transfer to CD4 T cells. DESIGN MDDCs were generated and milk and plasma-derived exosomes were isolated from healthy donors. To determine the capacity of exosomes to inhibit HIV-1 infection, MDDCs were preincubated with exosomes before exposure to HIV-1BaL. To investigate transfer of HIV-1 from MDDCs to CD4 T cells, MDDCs preincubated with exosomes and HIV-1BaL were cocultured with allogeneic CD4 T cells. To explore receptors used by MDDCs for binding of exosomes, blocking experiments were performed. METHODS Productive HIV-1 infection was analysed in MDDCs and CD4 T cells by determining p24 expression by flow cytometry. Confocal microscopy and flow cytometry was used to investigate uptake of fluorescently labelled exosomes by MDDCs. RESULTS Milk exosomes, but not plasma exosomes, bind MDDCs via DC-SIGN inhibiting HIV-1 infection of MDDCs and subsequent viral transfer to CD4 T cells. CONCLUSION We propose that milk exosomes act as a novel protective factor against vertical transmission of HIV-1 by competing with HIV-1 for binding to DC-SIGN on MDDCs.
Collapse
|
24
|
Tomasoni LR, Galli M, Declich S, Pietra V, Croce F, Pignatelli S, Fabiani M, Simporé J, Mabilia M, Ayella EO, Caracciolo C, Russo G, Guaraldi G, Gambirasio MN, Vullo V, Castelli F. Knowledge, attitudes and practice (KAP) regarding newborn feeding modalities in HIV-infected and HIV-uninfected pregnant women in sub-Saharan Africa: a multicentre study. Int Health 2013; 3:56-65. [PMID: 24038051 DOI: 10.1016/j.inhe.2010.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Exclusive formula feeding, exclusive breastfeeding (EBF) with early weaning or the administration of antiretroviral therapy to lactating mothers and/or to breastfed newborns may lower postnatal HIV transmission. The aim of this study was to assess mothers' knowledge, attitudes and practice (KAP) on lactation in various real-life settings in sub-Saharan Africa. A questionnaire survey investigating KAP with regard to breastfeeding in pregnant women of unknown status (Questionnaire A, 16 items) or HIV-infected women (Questionnaire B, 37 items) was administered. Associations between newborn feeding KAP and demographic, socioeconomic, cultural and obstetric variables were investigated. From January 2007 to January 2008, 2112 pregnant women answered Questionnaire A in Burkina Faso, Cameroon, Chad, Tanzania, Uganda and Zambia. Most women (53.0%) declared EBF as the preferred feeding modality. The practice of strictly defined EBF in previous pregnancies was only 11.4%, which was inversely correlated with education and parity. Questionnaire B was answered by 225 HIV-infected pregnant women in Burkina Faso, Tanzania and Uganda. Knowledge about the lactation-associated risk was associated with previous dead children. Significant variability was observed among collaborating sites. The introduction of fluids other than maternal milk within 6 months of age is common practice in sub-Saharan Africa, requiring intensive health education efforts if strictly defined EBF is to be adopted to decrease HIV postnatal transmission. Significant variation in newborn feeding determinants was observed.
Collapse
Affiliation(s)
- L R Tomasoni
- Department for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Maredza M, Bertram MY, Saloojee H, Chersich MF, Tollman SM, Hofman KJ. Cost-effectiveness analysis of infant feeding strategies to prevent mother-to-child transmission of HIV in South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2013; 12:151-60. [DOI: 10.2989/16085906.2013.863215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
26
|
Relationship between mortality and feeding modality among children born to HIV-infected mothers in a research setting: the Kesho Bora study. AIDS 2013; 27:1621-30. [PMID: 23262499 DOI: 10.1097/qad.0b013e32835d5226] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the relationship between infant feeding practices and mortality by 18 months of age among children born to HIV-infected mothers in the Kesho Bora trial (Burkina-Faso, Kenya and South Africa). METHODS Enrolled HIV-infected women were counseled to choose between breastfeeding up to 6 months or replacement feeding from delivery. Multivariable Cox models were used to compare the infant mortality risks according to feeding practices over time defined as never breastfed, weaned or still breastfed. The category 'still breastfed' was disaggregated as exclusively, predominantly or partially breastfed to compare modes of breastfeeding. The relationship between weaning and mortality was also assessed using marginal structural models to control for time-dependent confounders, such as maternal or infant morbidity (reverse causality). RESULTS Among 795 mothers, 618 (77.7%) initiated breastfeeding. Mortality rates by 18 months among uninfected and infected children were 6 and 38%, respectively. Never breastfed and weaned children were at greater risk of death compared with those still breastfed. Adjusted hazard ratios were 6.7 [95% confidence interval (CI)=2.5-17.9; P<0.001] and 6.9 (CI=2.8-17.2; P<0.001) for never breastfed and weaned children, respectively. Estimation of the effect of weaning using marginal structural models led to similar results. No statistically significant differences were observed according to mode of breastfeeding (exclusive, predominant or partial). CONCLUSION Within 6 months after birth, weaned or never breastfed children were at about seven-fold higher risk of dying compared with children who were still breastfed despite a context in which interventions were provided to reduce risks associated with replacement feeding.
Collapse
|
27
|
Krawinkel MB. Interaction of nutrition and infections globally: an overview. ANNALS OF NUTRITION AND METABOLISM 2013; 61 Suppl 1:39-45. [PMID: 23343946 DOI: 10.1159/000345162] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The interaction of nutrition and infections is known by experience by generations of medical doctors. Before the era of antibiotics, diet was an integral part of the management of infections. Now, it is necessary to take a fresh look at this interaction as the understanding of immune response has expanded considerably. Comparatively little research has addressed the impact of nutrition interventions on the management of infectious diseases. Most observations of the interaction between nutrition and infections are epidemiological in character. This holds especially true for measles as well as for tuberculosis. In AIDS, the deterioration of the nutritional status is an indicator of disease progression. Infections in undernourished children are a common cause of death, and taking this finding into account helps to reduce the case fatality rate in severely malnourished patients. Regarding the immune response, cellular as well as soluble components are affected by deficiencies of single nutrients or general undernutrition. The immunosuppressive effect of undernutrition starts during intrauterine life already: maternal nutrition status has been shown to impact on immune function in adult animals. Recent research suggests that not only undernutrition but also caloric overnutrition impacts on immune response to infections and immunization. This is partly due to the chronic inflammatory activity of the adipose tissue and partly due to neuroendocrine alterations. Infectious diseases also impact on the nutritional status, either specifically or through unspecific mechanisms, such as anorexia, tachypnea, and vomiting.
Collapse
Affiliation(s)
- M B Krawinkel
- Institute of Nutritional Sciences, Justus-Liebig University, Giessen, Germany
| |
Collapse
|
28
|
Natchu UCM, Liu E, Duggan C, Msamanga G, Peterson K, Aboud S, Spiegelman D, Fawzi WW. Exclusive breastfeeding reduces risk of mortality in infants up to 6 mo of age born to HIV-positive Tanzanian women. Am J Clin Nutr 2012; 96:1071-8. [PMID: 23053555 PMCID: PMC3471196 DOI: 10.3945/ajcn.111.024356] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite the benefits of exclusive breastfeeding (EBF), exposure to HIV from breast milk has relegated EBF to an option only when formula feeding is not affordable, feasible, safe, and sustainable. Mixed feeding remains the norm in sub-Saharan Africa. OBJECTIVE We evaluated whether the duration of EBF was associated with mortality and HIV infection in children followed to ≤5 y of age. METHODS A total of 690 mother-infant pairs from the Trial of Vitamins with information on infant feeding, HIV status, and at least one visit in the first year were included in the analysis. The duration of EBF was defined in months as a time-varying covariate at each follow-up visit. Associations of the duration of EBF with mortality, HIV infection, and HIV infection or death were estimated by using Cox proportional hazards models and Kaplan-Meier survival curves. RESULTS A 1-mo increase in EBF was associated with a 49% reduction in early infant mortality in the first 6 mo of life (RR: 0.51; 95% CI: 0.28, 0.93) and a nonsignificant 15% reduction in risk of HIV infection or death (RR: 0.85; 95% CI: 0.71, 1.01; P = 0.07) over the first 5 y of life. EBF was not associated with HIV infection (RR: 0.93; 95% CI: 0.76, 1.15). CONCLUSION Longer EBF by HIV-positive mothers was associated with reduced mortality in the first 6 mo of life without increased HIV infection, which makes EBF the best option for women who cannot sustain exclusive formula feeding. This trial was registered at clinicaltrials.gov as NCT00197743.
Collapse
Affiliation(s)
- Uma Chandra Mouli Natchu
- Department of Nutrition, Harvard School of Public Health, 655 Huntington Avenue, Building II Room 329A, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions, Northwest Ethiopia. BMC Public Health 2012; 12:240. [PMID: 22449092 PMCID: PMC3326701 DOI: 10.1186/1471-2458-12-240] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 03/26/2012] [Indexed: 11/16/2022] Open
Abstract
Background It has been estimated that 430,000 children under 15 years of age were newly infected with HIV in 2008, and more than 71% are living in sub-Saharan Africa. In the absence of intervention to prevent mother-to-child transmission, 30-45% of infants born to HIV-positive mothers in developing countries become infected during pregnancy, delivery and breastfeeding. The aim of this study was to assess infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics of Northwest Ethiopia. Methods Institution based cross sectional study was conducted from January to May 2011 among all HIV positive mothers with less than two years old child attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions. A structured pre-tested questionnaire using interview technique was used for data collection. The data was entered and analyzed using SPSS version 16 statistical package. Results A total of 209 HIV positive mothers were included in the study. Of these, 187 (89.5%) had followed the recommended way of infant feeding practice while significant percentage (10.5%) had practiced mixed breast feeding. In multivariate analysis, disclosure of HIV status with their spouse, insufficient breast milk and occupational status were found to be independently associated (p-value of < 0.05) with recommended infant feeding practice. Lack of resource, stigma of HIV/AIDS, and husband opposition were also obtained as factors that influenced choice of infant feeding options by respondents. Conclusions Higher proportion of respondents used the recommended way of infant feeding practice by WHO as well as by Ethiopian Ministry of Health. However, mixed feeding in the first 6 months of age, an undesirable practice in infant feeding, were reported in this study. Infant feeding education that is aligned to national policy should be strengthened in primary health care, particularly in situations where prevention of mother to child transmission of HIV is prioritized.
Collapse
|
30
|
Mother's CD4+ count moderates the risk associated with higher parity for late postnatal HIV-free survival of breastfed children: an individual patient data meta-analysis of randomized controlled trials. AIDS Behav 2012; 16:79-85. [PMID: 21739289 DOI: 10.1007/s10461-011-9989-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Risk association studies of late postnatal outcomes for children breastfed by HIV-1 positive mothers have had inconsistent findings and have not explored interactions among risk factors. This study addresses these limitations through an individual patient data (IPD) meta-analysis of HIV-free survival outcomes of nine randomized controlled trials to prevent early mother-to-child transmission of HIV-1. The pooled sample consisted of 3,324 African children in resource-limited settings who survived to age 28 days and were at-risk of acquiring HIV through breast milk. Based on a proportional hazards mixed effects meta-analysis, the composite endpoint of HIV-1 infection and all-cause mortality was found to be significantly associated with maternal immune status (CD4(+) ≥350 cells/mm(3), HR 0.59 95% CI (0.39, 0.87)), infant preterm delivery (gestational age <37 weeks, 1.40 (1.03, 1.89)), infant oral candidiasis infection (1.87, (1.53, 2.29)), and occurrence of breast abnormality before breastfeeding cessation (2.56 (1.90, 3.46)). A significant interaction between mother's parity (any previous pregnancy) and CD4(+) count ≥350 (HR 0.63 (0.40, 0.99), P-value = 0.045) suggested that higher CD4(+) count offsets the risk associated with higher parity. Further research is needed to elucidate the moderating effect of immune status on the risk associated with high parity and adverse late postnatal outcomes for infants breastfed by HIV-infected mothers in the absence of antiretroviral treatment.
Collapse
|
31
|
Ciaranello AL, Park JE, Ramirez-Avila L, Freedberg KA, Walensky RP, Leroy V. Early infant HIV-1 diagnosis programs in resource-limited settings: opportunities for improved outcomes and more cost-effective interventions. BMC Med 2011; 9:59. [PMID: 21599888 PMCID: PMC3129310 DOI: 10.1186/1741-7015-9-59] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/20/2011] [Indexed: 02/07/2023] Open
Abstract
Early infant diagnosis (EID) of HIV-1 infection confers substantial benefits to HIV-infected and HIV-uninfected infants, to their families, and to programs providing prevention of mother-to-child transmission (PMTCT) services, but has been challenging to implement in resource-limited settings. In order to correctly inform parents/caregivers of infant infection status and link HIV-infected infants to care and treatment, a 'cascade' of events must successfully occur. A frequently cited barrier to expansion of EID programs is the cost of the required laboratory assays. However, substantial implementation barriers, as well as personnel and infrastructure requirements, exist at each step in the cascade. In this update, we review challenges to uptake at each step in the EID cascade, highlighting that even with the highest reported levels of uptake, nearly half of HIV-infected infants may not complete the cascade successfully. We next synthesize the available literature about the costs and cost effectiveness of EID programs; identify areas for future research; and place these findings within the context of the benefits and challenges to EID implementation in resource-limited settings.
Collapse
Affiliation(s)
- Andrea L Ciaranello
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
| | - Ji-Eun Park
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lynn Ramirez-Avila
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Children's Hospital Boston, Boston, MA, USA
| | - Kenneth A Freedberg
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for AIDS Research, Harvard Medical School, Boston, MA, USA
| | - Rochelle P Walensky
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for AIDS Research, Harvard Medical School, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Valeriane Leroy
- Inserm, Unité 897, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Bordeaux Segalen, Bordeaux, France
| |
Collapse
|
32
|
Young SL, Israel-Ballard KA, Dantzer EA, Ngonyani MM, Nyambo MT, Ash DM, Chantry CJ. Infant feeding practices among HIV-positive women in Dar es Salaam, Tanzania, indicate a need for more intensive infant feeding counselling. Public Health Nutr 2010; 13:2027-33. [PMID: 20587116 PMCID: PMC3289716 DOI: 10.1017/s1368980010001539] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess feeding practices of infants born to HIV-positive women in Dar es Salaam, Tanzania. These data then served as a proxy to evaluate the adequacy of current infant feeding counselling. DESIGN A cross-sectional survey of infant feeding behaviours. SETTING Four clinics in greater Dar es Salaam in early 2008. SUBJECTS A total of 196 HIV-positive mothers of children aged 6-10 months recruited from HIV clinics. RESULTS Initiation of breast-feeding was reported by 95·4 % of survey participants. In the entire sample, 80·1 %, 34·2 % and 13·3 % of women reported exclusive breast-feeding (EBF) up to 2, 4 and 6 months, respectively. Median duration of EBF among women who ever breast-fed was 3 (interquartile range (IQR): 2·1, 4·0) months. Most non-breast-milk foods fed to infants were low in nutrient density. Complete cessation of breast-feeding occurred within 14 d of the introduction of non-breast-milk foods among 138 of the 187 children (73·8 %) who had ever received any breast milk. Of the 187 infants in the study who ever received breast milk, 19·4 % received neither human milk nor any replacement milks for 1 week or more (median duration of no milk was 14 (IQR: 7, 152) d). CONCLUSIONS Infant feeding practices among these HIV-positive mothers resulted in infants receiving far less breast milk and more mixed complementary feeds than recommended, thus placing them at greater risk of both malnutrition and HIV infection. An environment that better enables mothers to follow national guidelines is urgently needed. More intensive infant feeding counselling programmes would very likely increase rates of optimal infant feeding.
Collapse
Affiliation(s)
- Sera L Young
- Department of Pediatrics, University of California Davis Medical Center, Ticon II Building, Suite 334, 2516 Stockton Blvd, Davis, Sacramento, CA 95817, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Nlend AEN, Ekani BB. Preliminary assessment of breastfeeding practices in HIV 1-infected mothers (prior to weaning) under the Djoungolo programme on the prevention of mother-to-child transmission of HIV. J Trop Pediatr 2010; 56:436-9. [PMID: 20332220 DOI: 10.1093/tropej/fmq018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Human Immunodeficiency virus (HIV) transmission in a breastfeeding population varies from 20% to 45%. OBJECTIVE To evaluate breastfeeding practices and the early basic HIV transmission rate in HIV-exposed children in the Djoungolo health district (prevention of mother-to-child transmission HIV programme). METHODS A cross-sectional survey was conducted, targeting breastfeeding mothers recruited from an observational cohort of HIV-positive pregnant women intending to breastfeed. Routine immunological assessment was carried out for all pregnant HIV-positive women coupled with initiation to highly active anti-retroviral therapy (HAART) in those with CD4 cell counts below 350 mm(-3). Early virological diagnosis of HIV infection was done using real-time Polymerase Chain reaction (PCR) RNA for infants aged between 6 weeks and 6 months. Breastfeeding intervention and counselling support were also provided to respondents. RESULTS Out of 545 women, 287 births were registered of which 64 of the HIV-infected mothers opted for breastfeeding. The mean CD4 cell count was 446 mm(-3); 34.4% of women were taking HAART. The rate of initiation to breastfeeding was observed to be 53% within 1 h following delivery. At 13 weeks, 96.1% were still exclusively breastfeeding on demand with an average of six feedings in the daytime and three feedings during the night. Of the mothers, 18.5% reported at least one episode of breast and/or nipple pain and 4.9% of mothers were practicing mixed feeding. The early rate of HIV transmission among 47 infants assessed was observed to be 4.3% [95% confidence interval 1-10.1]. CONCLUSION In an HIV context, routine breastfeeding intervention support associated with access to anti-retroviral therapy for women yet requiring treatment for themselves reduces the practice of mixed feeding and slashes the early mother-to-child HIV transmission rate to 4.3% in breastfeeding populations.
Collapse
|
34
|
Okong P, Namaganda PK, Bassani L, Tabaro MM, Zanetto F, Mwebaze EB, Weimer L, Tomasoni L, Castelli F, Giuliano M. Maternal HIV status and infant feeding practices among Ugandan women. SAHARA J 2010; 7:24-9. [PMID: 21409292 PMCID: PMC11132657 DOI: 10.1080/17290376.2010.9724952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
To describe the infant feeding practices in the general population in Uganda, and to assess the impact of maternal HIV status on these practices, a questionnaire was administered to women attending the follow-up clinics for child vaccination. Among the mothers who were still breastfeeding at the time of interview (N=838), 61.4% of the HIV-infected women had planned to breastfeed for a maximum of 6 months, compared with 12.1% of the HIV-uninfected women (p<0.001). Among the women who were not breastfeeding at the time of interview (N=108), 82.5% of the HIV-infected women had stopped breastfeeding within 3 months, compared with 23.5% of the HIV-uninfected women (p<0.001). Only 2.1% of HIV-infected women seen up to 14 weeks postnatally practised mixed feeding, compared with 23.6% of HIV-uninfected women (p<0.001). After 6 months, however, 30% of the HIV-infected women and 55% of the HIV-uninfected mothers were using mixed feeding, with no significant differences. Programmes for the prevention of mother-to-child transmission of HIV should re-enforce counseling activities to address the issue of early weaning by HIV-infected women, and to support safe breastfeeding up to 6 months.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Liliana Weimer
- Unit of Pharmacology and Therapy of Viral Diseases of the Department of Therapeutic Research, Istituto Superiore di Sanità (The Italian National Institute of Health), Rome
| | - Lina Tomasoni
- Unit for Tropical and Imported Diseases, Spedali Civili General Hospital, Brescia
| | - Francesco Castelli
- Department for Mother and Child Care and Medical Biotechnologies, University of Brescia, Italy
| | - Marina Giuliano
- Unit of Pharmacology and Therapy of Viral Diseases of the Department of Therapeutic Research, Istituto Superiore di Sanità (The Italian National Institute of Health), Rome
| |
Collapse
|
35
|
Sabery N, Duggan C. A.S.P.E.N. clinical guidelines: nutrition support of children with human immunodeficiency virus infection. JPEN J Parenter Enteral Nutr 2010; 33:588-606. [PMID: 19892900 DOI: 10.1177/0148607109346276] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nasim Sabery
- Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | | |
Collapse
|
36
|
Becquet R, Ekouevi DK, Arrive E, Stringer JSA, Meda N, Chaix ML, Treluyer JM, Leroy V, Rouzioux C, Blanche S, Dabis F. Universal antiretroviral therapy for pregnant and breast-feeding HIV-1-infected women: towards the elimination of mother-to-child transmission of HIV-1 in resource-limited settings. Clin Infect Dis 2010; 49:1936-45. [PMID: 19916796 DOI: 10.1086/648446] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) remains a challenge in most resource-limited settings, particularly in Africa. Single-dose and short-course antiretroviral (ARV) regimens are only partially effective and have failed to achieve wide coverage despite their apparent simplicity. More potent ARV combinations are restricted to pregnant women who need treatment for themselves and are also infrequently used. Furthermore, postnatal transmission via breast-feeding is a serious additional threat. Modifications of infant feeding practices aim to reduce HIV-1 transmission through breast milk; replacement feeding is neither affordable nor safe for the majority of African women, and early breast-feeding cessation (eg, prior to 6 months of life) requires substantial care and nutritional counseling to be practiced safely. The recent roll out of ARV treatment has changed the paradigm of prevention of MTCT. To date, postnatal ARV interventions that have been evaluated target either maternal ARV treatment to selected breast-feeding women, with good efficacy, or single-drug postexposure prophylaxis for short periods of time to their neonates, with a partial efficacy and at the expense of acquisition of drug-related viral resistance. We hypothesize that a viable solution to eliminate pediatric AIDS lies in the universal provision of fully suppressive ARV regimens to all HIV-1-infected women through pregnancy, delivery, and the entire breast-feeding period. On the basis of available evidence, we suggest translating into practice the recently available evidence on this matter without any further delay.
Collapse
Affiliation(s)
- Renaud Becquet
- INSERM, Unité 897, Centre de Recherche Epidémiologie et Biostatistique, Bordeaux, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Kuhn L, Sinkala M, Thea DM, Kankasa C, Aldrovandi GM. HIV prevention is not enough: child survival in the context of prevention of mother to child HIV transmission. J Int AIDS Soc 2009; 12:36. [PMID: 20015345 PMCID: PMC2796993 DOI: 10.1186/1758-2652-12-36] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 12/11/2009] [Indexed: 11/10/2022] Open
Abstract
Clinical and epidemiologic research has identified increasingly effective interventions to reduce mother to child HIV transmission in resource-limited settings These scientific breakthroughs have been implemented in some programmes, although much remains to be done to improve coverage and quality of these programmes. But prevention of HIV transmission is not enough. It is necessary also to consider ways to improve maternal health and protect child survival. A win-win approach is to ensure that all pregnant and lactating women with CD4 counts of <350 cells/mm3 have access to antiretroviral therapy. On its own, this approach will substantially improve maternal health and markedly reduce mother to child HIV transmission during pregnancy and delivery and through breastfeeding. This approach can be combined with additional interventions for women with higher CD4 counts, either extended prophylaxis to infants or extended regimens of antiretroviral drugs to women, to reduce transmission even further. Attempts to encourage women to abstain from all breastfeeding or to shorten the optimal duration of breastfeeding have led to increases in mortality among both uninfected and infected children. A better approach is to support breastfeeding while strengthening programmes to provide antiretroviral therapy for pregnant and lactating women who need it and offering antiretroviral drug interventions through the duration of breastfeeding. This will lead to reduced HIV transmission and will protect the health of women without compromising the health and well-being of infants and young children.
Collapse
Affiliation(s)
- Louise Kuhn
- Gertrude H, Sergievsky Center, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | | | | | | | | |
Collapse
|
38
|
Infant feeding counseling: a neglected strategy for the reduction of mother-to-child transmission. AIDS 2009; 23:2543-4; author reply 2544. [PMID: 19907213 DOI: 10.1097/qad.0b013e32833202d0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Jackson DJ, Goga AE, Doherty T, Chopra M. An update on HIV and infant feeding issues in developed and developing countries. J Obstet Gynecol Neonatal Nurs 2009; 38:219-29. [PMID: 19323719 DOI: 10.1111/j.1552-6909.2009.01014.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The field of mother to child transmission of human-immunodeficiency virus is rapidly evolving. In the United States, prevention focuses on implementation of universal human-immunodeficiency virus testing to assure compliance with recommended treatment regimens and infant-feeding strategies. In most cases, this is the avoidance of all breastfeeding. In developing countries, avoidance of breastfeeding places infants at higher risk of morbidity and mortality. Current World Health Organization recommendations require individualized counseling to determine the best feeding method for each woman.
Collapse
Affiliation(s)
- Debra J Jackson
- School of Public Health at the University of the Western Cape, Cape Town, South Africa.
| | | | | | | |
Collapse
|
40
|
Abstract
PURPOSE OF REVIEW In developing countries where replacement feeding is generally not feasible or safe, hundreds of thousands of infants acquire HIV infection during breastfeeding. Data from recently completed studies provide insight into the safety and hazards of different feeding approaches as well as the use of antiretroviral therapy to prevent postnatal transmission. RECENT FINDINGS Several studies confirm that the benefits of avoiding or shortening breastfeeding are offset by adverse outcomes in those infants who escape infection. Reductions in HIV transmission achieved with either formula feeding or early weaning are counterbalanced by increases in uninfected child mortality resulting in no net benefit for HIV-free survival. However, exclusive breastfeeding is associated with a significant decrease in HIV transmission risk. Antiretroviral treatment during breastfeeding to the mother or her infant appears to reduce the risk of postnatal transmission. Studies evaluating daily nevirapine to the breastfeeding infant suggest protection during the period of treatment. Similarly, infants born to breastfeeding women receiving antiretroviral therapy are at lower risk of acquiring HIV. SUMMARY While awaiting further studies defining optimal approaches to preventing HIV transmission during breastfeeding, promoting exclusive breastfeeding and assuring antiretroviral treatment for women with advanced HIV disease will likely prevent the majority of needless maternal and infant deaths.
Collapse
|
41
|
Horvath T, Madi BC, Iuppa IM, Kennedy GE, Rutherford G, Read JS. Interventions for preventing late postnatal mother-to-child transmission of HIV. Cochrane Database Syst Rev 2009; 2009:CD006734. [PMID: 19160297 PMCID: PMC7389566 DOI: 10.1002/14651858.cd006734.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Worldwide, mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV) represents the most common means by which children acquire HIV infection. Efficacious and effective interventions to prevent in utero and intrapartum transmission of HIV infection have been developed and implemented. However, a large proportion of MTCT of HIV occurs postnatally, through breast milk transmission. OBJECTIVES The objectives of this systematic review were to collate and assess the evidence regarding interventions to decrease late postnatal MTCT of HIV, and to determine the efficacy of such interventions in decreasing late postnatal MTCT of HIV, increasing overall survival, and increasing HIV-free survival. SEARCH STRATEGY Electronic searches were undertaken using PubMed, EMBASE and other databases for 1980-2008. Hand searches of reference lists of pertinent reviews and studies, as well as abstracts from relevant conferences, were also conducted. Experts in the field were contacted to locate any other studies. The search strategy was iterative. SELECTION CRITERIA Randomized clinical trials assessing the efficacy of interventions to prevent MTCT of HIV through breast milk were included in the analysis. Other trials and intervention cohort studies with relevant data also were included, but only when randomization was not feasible due to the nature of the intervention (i.e., infant feeding modality). DATA COLLECTION AND ANALYSIS Data regarding HIV infection status and vital status of infants born to HIV-infected women, according to intervention, were extracted from the reports of the studies. MAIN RESULTS Six randomized clinical trials and one intervention cohort study were included in this review. Two trials addressed the issue of shortening the duration of (or eliminating) exposure to breast milk. In a trial of breastfeeding versus formula feeding, formula feeding was efficacious in preventing MTCT of HIV (the cumulative probability of HIV infection at 24 months was 36.7% in the breastfeeding arm and 20.5% in the formula arm [p = 0.001]), but the mortality and malnutrition rates during the first two years of life were similar in the two groups. In a trial of early cessation of breastfeeding, HIV-free survival was similar between those children who ceased breastfeeding around four months of age and those who continued breastfeeding. Another trial addressing vitamin supplementation found more cases of HIV infection among children of mothers in the vitamin A arm. Efficacy for other vitamin supplements was not shown. An intervention cohort study evaluated the risk of MTCT according to infant feeding modality, and found increased risks of MTCT among breastfed children who also received solids (hazard ratio = 10.87, p = 0.018) as well as higher 3-month mortality rates (hazard ratio = 2.06) among infants given non- breast milk feedings (instead of exclusive breastfeeding). Three trials evaluated antiretroviral prophylaxis to breastfeeding infants. One trial found that breastfeeding with zidovudine prophylaxis (transmission rate = 9.0%) was not as effective as formula feeding (transmission rate 5.6%) in preventing late postnatal HIV transmission (p = 0.04). Breastfeeding with zidovudine prophylaxis and formula feeding had comparable HIV-free survival rates at 18 months (p = 0.60). Two trials of extended nevirapine prophylaxis demonstrated efficacy. In the first (data combined from trials conducted in three different countries), a six-week course of nevirapine resulted in a lower risk of HIV transmission by six weeks of age (p=0.009), but not at six months of age (p = 0.016). In the second, nevirapine administration until 14 weeks of age (5.2%) or nevirapine with zidovudine until 14 weeks of age (6.4%) resulted in significantly lower risks of MTCT of HIV by 9 months of age than a control regimen of peripartum prophylaxis (10.6%) (p < 0.001). HIV-free survival was significantly better through the age of 9 months in both extended prophylaxis groups, and through the age of 15 months in the extended nevirapine group. AUTHORS' CONCLUSIONS Complete avoidance of breastfeeding is efficacious in preventing MTCT of HIV, but this intervention has significant associated morbidity (e.g., diarrheal morbidity if formula is prepared without clean water). If breastfeeding is initiated, two interventions 1). exclusive breastfeeding during the first few months of life; and 2) chronic antiretroviral prophylaxis to the infant (nevirapine alone, or nevirapine with zidovudine) are efficacious in preventing transmission.
Collapse
Affiliation(s)
- Tara Horvath
- Global Health Sciences, University of California, San Francisco, Box 1224, San Francisco, California 94143, USA.
| | | | | | | | | | | |
Collapse
|
42
|
Solomons N, Hernell O. A perspective on the inappropriate infant feeding practices observed among KwaZulu-Natal mothers: Professional expectations clash with human nature’s realities. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2009. [DOI: 10.1080/16070658.2009.11734219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
43
|
Affiliation(s)
- William T Shearer
- Department of Pediatrics, Section of Allergy and Immunology, Baylor College of Medicine, Houston, Texa, USA.
| |
Collapse
|