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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 mo of life: the Kesho Bora study<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn1"><sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn2"><sup>3</sup>
</xref>
<xref ref-type="author-notes" rid="fn3"><sup>4</sup>
</xref>
<xref ref-type="author-notes" rid="fn4"><sup>5</sup>
</xref>
<xref ref-type="corresp" rid="cor1"><sup>6</sup>
</xref>
</title>
<author><name sortKey="Bork, Kirsten A" sort="Bork, Kirsten A" uniqKey="Bork K" first="Kirsten A" last="Bork">Kirsten A. Bork</name>
</author>
<author><name sortKey="Cournil, Amandine" sort="Cournil, Amandine" uniqKey="Cournil A" first="Amandine" last="Cournil">Amandine Cournil</name>
</author>
<author><name sortKey="Read, Jennifer S" sort="Read, Jennifer S" uniqKey="Read J" first="Jennifer S" last="Read">Jennifer S. Read</name>
</author>
<author><name sortKey="Newell, Marie Louise" sort="Newell, Marie Louise" uniqKey="Newell M" first="Marie-Louise" last="Newell">Marie-Louise Newell</name>
</author>
<author><name sortKey="Cames, Cecile" sort="Cames, Cecile" uniqKey="Cames C" first="Cécile" last="Cames">Cécile Cames</name>
</author>
<author><name sortKey="Meda, Nicolas" sort="Meda, Nicolas" uniqKey="Meda N" first="Nicolas" last="Meda">Nicolas Meda</name>
</author>
<author><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name>
</author>
<author><name sortKey="Mbatia, Grace" sort="Mbatia, Grace" uniqKey="Mbatia G" first="Grace" last="Mbatia">Grace Mbatia</name>
</author>
<author><name sortKey="Naidu, Kevindra" sort="Naidu, Kevindra" uniqKey="Naidu K" first="Kevindra" last="Naidu">Kevindra Naidu</name>
</author>
<author><name sortKey="Gaillard, Philippe" sort="Gaillard, Philippe" uniqKey="Gaillard P" first="Philippe" last="Gaillard">Philippe Gaillard</name>
</author>
<author><name sortKey="De Vincenzi, Isabelle" sort="De Vincenzi, Isabelle" uniqKey="De Vincenzi I" first="Isabelle" last="De Vincenzi">Isabelle De Vincenzi</name>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">25411291</idno>
<idno type="pmc">4232020</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232020</idno>
<idno type="RBID">PMC:4232020</idno>
<idno type="doi">10.3945/ajcn.113.082149</idno>
<date when="2014">2014</date>
<idno type="wicri:Area/Pmc/Corpus">001576</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001576</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 mo of life: the Kesho Bora study<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn1"><sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn2"><sup>3</sup>
</xref>
<xref ref-type="author-notes" rid="fn3"><sup>4</sup>
</xref>
<xref ref-type="author-notes" rid="fn4"><sup>5</sup>
</xref>
<xref ref-type="corresp" rid="cor1"><sup>6</sup>
</xref>
</title>
<author><name sortKey="Bork, Kirsten A" sort="Bork, Kirsten A" uniqKey="Bork K" first="Kirsten A" last="Bork">Kirsten A. Bork</name>
</author>
<author><name sortKey="Cournil, Amandine" sort="Cournil, Amandine" uniqKey="Cournil A" first="Amandine" last="Cournil">Amandine Cournil</name>
</author>
<author><name sortKey="Read, Jennifer S" sort="Read, Jennifer S" uniqKey="Read J" first="Jennifer S" last="Read">Jennifer S. Read</name>
</author>
<author><name sortKey="Newell, Marie Louise" sort="Newell, Marie Louise" uniqKey="Newell M" first="Marie-Louise" last="Newell">Marie-Louise Newell</name>
</author>
<author><name sortKey="Cames, Cecile" sort="Cames, Cecile" uniqKey="Cames C" first="Cécile" last="Cames">Cécile Cames</name>
</author>
<author><name sortKey="Meda, Nicolas" sort="Meda, Nicolas" uniqKey="Meda N" first="Nicolas" last="Meda">Nicolas Meda</name>
</author>
<author><name sortKey="Luchters, Stanley" sort="Luchters, Stanley" uniqKey="Luchters S" first="Stanley" last="Luchters">Stanley Luchters</name>
</author>
<author><name sortKey="Mbatia, Grace" sort="Mbatia, Grace" uniqKey="Mbatia G" first="Grace" last="Mbatia">Grace Mbatia</name>
</author>
<author><name sortKey="Naidu, Kevindra" sort="Naidu, Kevindra" uniqKey="Naidu K" first="Kevindra" last="Naidu">Kevindra Naidu</name>
</author>
<author><name sortKey="Gaillard, Philippe" sort="Gaillard, Philippe" uniqKey="Gaillard P" first="Philippe" last="Gaillard">Philippe Gaillard</name>
</author>
<author><name sortKey="De Vincenzi, Isabelle" sort="De Vincenzi, Isabelle" uniqKey="De Vincenzi I" first="Isabelle" last="De Vincenzi">Isabelle De Vincenzi</name>
</author>
</analytic>
<series><title level="j">The American Journal of Clinical Nutrition</title>
<idno type="ISSN">0002-9165</idno>
<idno type="eISSN">1938-3207</idno>
<imprint><date when="2014">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><p><bold>Background:</bold>
Refraining from breastfeeding to prevent HIV transmission has been associated with increased morbidity and mortality in HIV-exposed African infants.</p>
<p><bold>Objective:</bold>
The objective was to assess risks of common and serious infectious morbidity by feeding mode in HIV-exposed, uninfected infants ≤6 mo of age with special attention to the issue of reverse causality.</p>
<p><bold>Design:</bold>
HIV-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the prevention of mother-to-child transmission Kesho Bora trial and counseled to either breastfeed exclusively and cease by 6 mo postpartum or formula feed exclusively. Maternal-reported morbidity (fever, diarrhea, and vomiting) and serious infectious events (SIEs) (gastroenteritis and lower respiratory tract infections) were investigated for 751 infants for 2 age periods (0–2.9 and 3–6 mo) by using generalized linear mixed models with breastfeeding as a time-dependent variable and adjustment for study site, maternal education, economic level, and cotrimoxazole prophylaxis.</p>
<p><bold>Results:</bold>
Reported morbidity was not significantly higher in nonbreastfed compared with breastfed infants [OR: 1.31 (95% CI: 0.97, 1.75) and 1.21 (0.90, 1.62) at 0–2.9 and 3–6 mo of age, respectively]. Between 0 and 2.9 mo of age, never-breastfed infants had increased risks of morbidity compared with those of infants who were exclusively breastfed (OR: 1.49; 95% CI: 1.01, 2.2; <italic>P</italic>
= 0.042). The adjusted excess risk of SIEs in nonbreastfed infants was large between 0 and 2.9 mo (OR: 6.0; 95% CI: 2.2, 16.4; <italic>P</italic>
= 0.001). Between 3 and 6 mo, the OR for SIEs was sensitive to the timing of breastfeeding status, i.e., 4.3 (95% CI: 1.2, 15.3; <italic>P</italic>
= 0.02) when defined at end of monthly intervals and 2.0 (95% CI: 0.8, 5.0; <italic>P</italic>
= 0.13) when defined at the beginning of intervals. Of 52 SIEs, 3 mothers reported changes in feeding mode during the SIE although none of the mothers ceased breastfeeding completely.</p>
<p><bold>Conclusions:</bold>
Not breastfeeding was associated with increased risk of serious infections especially between 0 and 2.9 mo of age. The randomized controlled trial component of the Kesho Bora study was registered at Current Controlled Trials (<ext-link ext-link-type="uri" xlink:href="www.controlled-trials.com">www.controlled-trials.com</ext-link>
) as ISRCTN71468401.</p>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Am J Clin Nutr</journal-id>
<journal-id journal-id-type="iso-abbrev">Am. J. Clin. Nutr</journal-id>
<journal-id journal-id-type="publisher-id">ajcn</journal-id>
<journal-title-group><journal-title>The American Journal of Clinical Nutrition</journal-title>
</journal-title-group>
<issn pub-type="ppub">0002-9165</issn>
<issn pub-type="epub">1938-3207</issn>
<publisher><publisher-name>American Society for Nutrition</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">25411291</article-id>
<article-id pub-id-type="pmc">4232020</article-id>
<article-id pub-id-type="publisher-id">082149</article-id>
<article-id pub-id-type="doi">10.3945/ajcn.113.082149</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>International Nutrition</subject>
</subj-group>
</article-categories>
<title-group><article-title>Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 mo of life: the Kesho Bora study<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn1"><sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn2"><sup>3</sup>
</xref>
<xref ref-type="author-notes" rid="fn3"><sup>4</sup>
</xref>
<xref ref-type="author-notes" rid="fn4"><sup>5</sup>
</xref>
<xref ref-type="corresp" rid="cor1"><sup>6</sup>
</xref>
</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Bork</surname>
<given-names>Kirsten A</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Cournil</surname>
<given-names>Amandine</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Read</surname>
<given-names>Jennifer S</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Newell</surname>
<given-names>Marie-Louise</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Cames</surname>
<given-names>Cécile</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Meda</surname>
<given-names>Nicolas</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Luchters</surname>
<given-names>Stanley</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Mbatia</surname>
<given-names>Grace</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Naidu</surname>
<given-names>Kevindra</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Gaillard</surname>
<given-names>Philippe</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>de Vincenzi</surname>
<given-names>Isabelle</given-names>
</name>
</contrib>
<aff id="aff1"><label>1</label>
From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the<italic>Eunice Kennedy Shriver</italic>
National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV).</aff>
</contrib-group>
<author-notes><fn id="fn1"><label>2</label>
<p>The results of this article were presented in part at Experimental Biology, Boston, MA, 20–24 April 2013.</p>
</fn>
<fn id="fn2"><label>3</label>
<p>The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the WHO, the Centers for Disease Control and Prevention, or the NIH.</p>
</fn>
<fn id="fn3"><label>4</label>
<p>Supported by funding from the Agence Nationale de Recherche sur le Sida et les Hépatites Virales (ANRS), the Department for International Development (DFID), the European and Developing Countries Clinical Trials Partnership (EDCTP), the Thrasher Research Fund, the Belgian Directorate General for International Cooperation, the GlaxoSmithKline Foundation, the CDC, the <italic>Eunice Kennedy Shriver </italic>
National Institute of Child Health and Human Development, and the United Nations Development Program (UNDP)/United Nations Population Fund (UNFPA)/World Bank/WHO Special Programme of Research, Development and Research Training in Human Reproduction. The Bobo-Dioulasso site was funded by the ANRS and the UNDP/UNFPA/World Bank/WHO Special Programme of Research, Development and Research Training in Human Reproduction (WHO/HRP). The Mombasa site was funded by the ANRS, WHO/HRP, EDCTP, Thrasher Research Fund, and Belgian Directorate General for International Cooperation. The Nairobi site was funded by the CDC and the <italic>Eunice Kennedy Shriver</italic>
National Institute of Child Health and Human Development through a cooperative agreement. South African sites were funded by the DFID, EDCTP, United Nations Children's Fund, and WHO/HRP. The nutrition and laboratory coordination were funded by the ANRS. The overall coordination and external monitoring was funded by the WHO/HRP.</p>
</fn>
<fn id="fn4"><label>5</label>
<p>Present address for JSR: Division of Infectious Diseases, Department of Pediatrics, George Washington University School of Medicine, Washington, DC; for M-LN: Faculty of Medicine, University of Southampton, Southampton, United Kingdom; and for SL: Burnet Institute, Melbourne, Australia.</p>
</fn>
<corresp id="cor1"><label>6</label>
Address correspondence to K Bork, UMI233, Institut de Recherche pour le Développement/Université de Montpellier 1, BP 64501, 34394 Montpellier Cedex 5, France. E-mail: <email xlink:type="simple">kirsten.bork@ird.fr</email>
.</corresp>
</author-notes>
<pmc-comment>Fake ppub date generated by PMC from publisher pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub"><month>12</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub"><day>22</day>
<month>10</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>1</day>
<month>12</month>
<year>2015</year>
</pub-date>
<pmc-comment> PMC Release delay is 12 months and 0 days and was based on the . </pmc-comment>
<volume>100</volume>
<issue>6</issue>
<fpage>1559</fpage>
<lpage>1568</lpage>
<history><date date-type="received"><day>7</day>
<month>1</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>1</day>
<month>10</month>
<year>2014</year>
</date>
</history>
<permissions><copyright-statement>© 2014 American Society for Nutrition</copyright-statement>
<copyright-year>2014</copyright-year>
</permissions>
<abstract><p><bold>Background:</bold>
Refraining from breastfeeding to prevent HIV transmission has been associated with increased morbidity and mortality in HIV-exposed African infants.</p>
<p><bold>Objective:</bold>
The objective was to assess risks of common and serious infectious morbidity by feeding mode in HIV-exposed, uninfected infants ≤6 mo of age with special attention to the issue of reverse causality.</p>
<p><bold>Design:</bold>
HIV-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the prevention of mother-to-child transmission Kesho Bora trial and counseled to either breastfeed exclusively and cease by 6 mo postpartum or formula feed exclusively. Maternal-reported morbidity (fever, diarrhea, and vomiting) and serious infectious events (SIEs) (gastroenteritis and lower respiratory tract infections) were investigated for 751 infants for 2 age periods (0–2.9 and 3–6 mo) by using generalized linear mixed models with breastfeeding as a time-dependent variable and adjustment for study site, maternal education, economic level, and cotrimoxazole prophylaxis.</p>
<p><bold>Results:</bold>
Reported morbidity was not significantly higher in nonbreastfed compared with breastfed infants [OR: 1.31 (95% CI: 0.97, 1.75) and 1.21 (0.90, 1.62) at 0–2.9 and 3–6 mo of age, respectively]. Between 0 and 2.9 mo of age, never-breastfed infants had increased risks of morbidity compared with those of infants who were exclusively breastfed (OR: 1.49; 95% CI: 1.01, 2.2; <italic>P</italic>
= 0.042). The adjusted excess risk of SIEs in nonbreastfed infants was large between 0 and 2.9 mo (OR: 6.0; 95% CI: 2.2, 16.4; <italic>P</italic>
= 0.001). Between 3 and 6 mo, the OR for SIEs was sensitive to the timing of breastfeeding status, i.e., 4.3 (95% CI: 1.2, 15.3; <italic>P</italic>
= 0.02) when defined at end of monthly intervals and 2.0 (95% CI: 0.8, 5.0; <italic>P</italic>
= 0.13) when defined at the beginning of intervals. Of 52 SIEs, 3 mothers reported changes in feeding mode during the SIE although none of the mothers ceased breastfeeding completely.</p>
<p><bold>Conclusions:</bold>
Not breastfeeding was associated with increased risk of serious infections especially between 0 and 2.9 mo of age. The randomized controlled trial component of the Kesho Bora study was registered at Current Controlled Trials (<ext-link ext-link-type="uri" xlink:href="www.controlled-trials.com">www.controlled-trials.com</ext-link>
) as ISRCTN71468401.</p>
</abstract>
<kwd-group><title>Keywords</title>
<kwd>Africa</kwd>
<kwd>HIV/AIDS</kwd>
<kwd>diarrhea</kwd>
<kwd>infant feeding</kwd>
<kwd>infections</kwd>
</kwd-group>
<counts><page-count count="10"></page-count>
</counts>
</article-meta>
</front>
</pmc>
</record>
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