Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial

Nduati, Ruth; Richardson, Barbra A.; John, Grace C.; Mbori‐Ngacha, Dorothy; Mwatha, Anthony; Ndinya‐Achola, Jeckoniah; Bwayo, Job; Onyango, Francis; Kreiss, Joan K.

doi:10.1016/s0140-6736(00)04820-0

Cited by 171 publications

(64 citation statements)

References 21 publications

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“…A randomized trial conducted in Kenya compared breastfeeding to formula feed--ing and reported there was an increased risk of maternal death among women who breastfed their infants. 10 However, the number of events in this second--ary analysis was small (24 deaths). Two subsequent observational studies from South Africa and the United Republic of Tanzania found no association between breastfeeding and maternal mortality among women infected with HIV.…”

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confidence: 83%

The impact of breastfeeding on the health of HIV-positive mothers and their children in sub-Saharan Africa

Taha

Kumwenda

Hoover

et al. 2006

Bull World Health Organ

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ObjectiveWe assessed the impact of breastfeeding by women infected with human immunodeficiency virus (HIV)-1 on their morbidity and risk of mortality and on the mortality of their children. Methods We analysed longitudinal data from two previous randomized clinical trials of mother-to-child transmission of HIV conducted between April 2000 and March 2003 in the Republic of Malawi, Africa. Mothers infected with HIV, and their newborns, were enrolled at the time of their child's birth; they then returned for follow-up visits when the child was aged 1 week, 6-8 weeks and then 3, 6, 9, 15, 18, 21 and 24 months. Patterns of breastfeeding (classified as exclusive, mixed or no breastfeeding), maternal morbidity and mortality, and mortality among their children were assessed at each visit. Descriptive and multivariate analyses were performed to determine the association between breastfeeding and maternal and infant outcomes. Findings A total of 2000 women infected with HIV were enrolled in the original studies. During the 2 years after birth, 44 (2.2%) mothers and 310 (15.5%) children died. (Multiple births were excluded.) The median duration of breastfeeding was 18 months (interquartile range (IQR) = 9.0-22.5), exclusive breastfeeding 2 months (IQR = 2-3) and mixed feeding 12 months (IQR = 6-18). Breastfeeding patterns were not significantly associated with maternal mortality or morbidity after adjusting for maternal viral load and other covariates. Breastfeeding was associated with reduced mortality among infants and children: the adjusted hazard ratio for overall breastfeeding was 0.44 (95% confidence interval (CI) = 0.28-0.70), for mixed feeding 0.45 (95% CI = 0.28-0.71) and for exclusive breastfeeding 0.40 (95% CI = 0.22-0.72). These protective effects were seen both in infants who were infected with HIV and those who were not. Conclusion Breastfeeding by women infected with HIV was not associated with mortality or morbidity; it was associated with highly significant reductions in mortality among their children. Voir page 552 le résumé en français. En la página 553 figura un resumen en español. IntroductionIn sub-Saharan Africa, women infected with human immunondeficiency virus (HIV)-1 continue to breastfeed their infants for several reasons. Breastfeed--ing satisfies the nutritional needs of an infant and is frequently encouraged by other family members as a cultural norm. Women who do not initiate and maintain breastfeeding raise suspicion in the community about their HIV status, and this may lead to discrimination. Furthermore, substitutes for breast milk are either expensive or not safe to use owing to a lack of safe water, and con--tainers for feeding the infant are easily contaminated. However, breastfeeding is the most important route of postnatal HIV trans--mission to the infant. 7 To counterbalance the benefits and risks of breastfeeding when the mother is infected with HIV, WHO, UNICEF and others have devel--oped guidelines to assist women in mak--ing an informed decision about whether to breastfeed. 8 In ...

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confidence: 83%

The impact of breastfeeding on the health of HIV-positive mothers and their children in sub-Saharan Africa

Taha

Kumwenda

Hoover

et al. 2006

Bull World Health Organ

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“…6,7 Infant factors that predict rapid disease progression include early acquisition of HIV, high viral load, early CD4 depletion and early onset of HIV-related symptoms such as growth delay, neurodevelopmental delay, hepatomegaly, splenomegaly and lymphadenopathy. [4][5][6][8][9][10][11][12] In the absence of HIV-1 infection, breast milk is known to protect against infectious disease and mortality in infancy through provision of passive immunity and nutrition to the infant.…”

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confidence: 99%

Predictors of Early Mortality in a Cohort of Human Immunodeficiency Virus Type 1-Infected African Children

Obimbo

Mbori‐Ngacha

Ochieng

et al. 2004

The Pediatric Infectious Disease Journal

108

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“…Following this landmark study, different ART regimens have demonstrated variable impact in the reduction of HIV-1 vertical transmission rates (Dabis et al 1999, Guay et al 1999, Shaffer et al 1999, Wiktor et al 1999, PST 2002, Lallemant et al 2004, Read et al 2007). In addition to ART, other interventions have contributed to the reduction of HIV-1 vertical transmission, such as elective cesarean section (C-section) (IPHIVG 1999, EMDC 1999, vaginal cleaning during the intrapartum period (Taha et al 1997), vitamin A supplementation (Semba 1997), and avoidance of breastfeeding (Nduati et al 2001, RoUsseau et al 2004.…”

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Determinants and trends in perinatal human immunodeficiency virus type 1 (HIV-1) transmission in the metropolitan area of Belo Horizonte, Brazil: 1998 - 2005

Kakehasi

Pinto

Romanelli

et al. 2008

Mem. Inst. Oswaldo Cruz

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Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial

Abstract: Our findings suggest that breastfeeding by HIV-1 infected women might result in adverse outcomes for both mother and infant.

Cited by 171 publications

References 21 publications

The impact of breastfeeding on the health of HIV-positive mothers and their children in sub-Saharan Africa

The impact of breastfeeding on the health of HIV-positive mothers and their children in sub-Saharan Africa

Predictors of Early Mortality in a Cohort of Human Immunodeficiency Virus Type 1-Infected African Children

Determinants and trends in perinatal human immunodeficiency virus type 1 (HIV-1) transmission in the metropolitan area of Belo Horizonte, Brazil: 1998 - 2005

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