Effects of Early, Abrupt Weaning on HIV-free Survival of Children in Zambia

Abstract

Early, abrupt cessation of breast-feeding by HIV-infected women in a low-resource setting, such as Lusaka, Zambia, does not improve the rate of HIV-free survival among children born to HIV-infected mothers and is harmful to HIV-infected infants.(ClinicalTrials.gov number, NCT00310726.)

HIV and infant feeding – one step forward, two steps back

“…However, the extremely high background mortality in the study children (e.g. 21% in Zambia) 6 because of the high burden of infectious disease, poor hygiene and sanitation, and limited access to quality health care, easily masks any possible benefits of replacement feeding (since so many children die). These dismal conditions are much less likely in South African settings.…”

The aetiology of diarrhoea, pneumonia and respiratory colonization of HIV-exposed infants randomized to breast- or formula-feeding

“…[1][2][3] Mortality in HIV-infected and HIV-exposed but uninfected (HEU) infants is primarily caused by respiratory and diarrhoeal diseases. [4][5][6][7][8][9] However, the specific pathogens causing these infections are largely unknown because of barriers to diagnostic testing in resource-limited settings. Therefore, the contribution of the usual bacterial and viral pathogens to excess mortality in HEU is poorly described.…”

Optimizing HIV‐1‐specific CD8+ T‐cell induction by recombinant BCG in prime‐boost regimens with heterologous viral vectors

“…Although antiretroviral treatment substantially decreases mother-to-child transmission (MTCT) of HIV-1 [3], it is not ideal due to the cost, requirement for daily compliance, side effects and possible development of drug resistance. Because breast milk provides essential nutrients and protection against other diseases in the early days of life [4,5], formula as an HIV-1-free alternative is recommended only if it is acceptable, feasible, affordable, sustainable and safe (AFASS) and thus it is not an option for many HIV-1-positive mothers in Africa. The best hope for protecting newborns and infants in the 'South' (and in the 'North') against acquiring HIV-1 from their infected mothers while breastfeeding remains the development of safe, effective and accessible adult and pediatric vaccines [6].…”

“…other diseases in the early days of life [4,5], formula as an HIV-1-free alternative is recommended only if it is acceptable, feasible, affordable, sustainable and safe (AFASS) and thus it is not an option for many HIV-1-positive mothers in Africa. The best hope for protecting newborns and infants in the 'South' (and in the 'North') against acquiring HIV-1 from their infected mothers while breastfeeding remains the development of safe, effective and accessible adult and pediatric vaccines [6].…”