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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Morbidity and Mortality in Breastfed and Formula-Fed Infants of HIV-1–Infected Women A Randomized Clinical Trial</title><author><name sortKey="Mbori Ngacha, Dorothy" sort="Mbori Ngacha, Dorothy" uniqKey="Mbori Ngacha D" first="Dorothy" last="Mbori-Ngacha">Dorothy Mbori-Ngacha</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">11712936</idno><idno type="pmc">3358136</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358136</idno><idno type="RBID">PMC:3358136</idno><date when="2001">2001</date><idno type="wicri:Area/Pmc/Corpus">001B57</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001B57</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Morbidity and Mortality in Breastfed and Formula-Fed Infants of HIV-1–Infected Women A Randomized Clinical Trial</title><author><name sortKey="Mbori Ngacha, Dorothy" sort="Mbori Ngacha, Dorothy" uniqKey="Mbori Ngacha D" first="Dorothy" last="Mbori-Ngacha">Dorothy Mbori-Ngacha</name></author></analytic><series><title level="j">Jama</title><idno type="ISSN">0098-7484</idno><idno type="eISSN">1538-3598</idno><imprint><date when="2001">2001</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Context</title><p id="P1">Breastfeeding among women infected with human immunodeficiency virus type 1 (HIV-1) is associated with substantial risk of HIV-1 transmission, but little is known about the morbidity risks associated with formula feeding in infants of HIV-1–infected women in resource-poor settings.</p></sec><sec id="S2"><title>Objective</title><p id="P2">To compare morbidity, nutritional status, mortality adjusted for HIV-1 status, and cause of death among formula-fed and breastfed infants of HIV-1–infected women.</p></sec><sec id="S3"><title>Design</title><p id="P3">Randomized clinical trial conducted between 1992 and 1998.</p></sec><sec id="S4"><title>Setting</title><p id="P4">Four antenatal clinics in Nairobi, Kenya.</p></sec><sec id="S5"><title>Participants</title><p id="P5">Of 401 live-born, singleton, or first-born twin infants of randomized HIV-1–seropositive mothers, 371 were included in the analysis of morbidity and mortality.</p></sec><sec id="S6"><title>Interventions</title><p id="P6">Mothers were randomly assigned either to use formula (n=186) or to breastfeed (n=185) their infants.</p></sec><sec id="S7"><title>Main Outcome Measures</title><p id="P7">Mortality rates, adjusted for HIV-1 infection status; morbidity; and nutritional status during the first 2 years of life.</p></sec><sec id="S8"><title>Results</title><p id="P8">Two-year estimated mortality rates among infants were similar in the formula-feeding and breastfeeding arms (20.0% vs 24.4%; hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.5–1.3), even after adjusting for HIV-1 infection status (HR, 1.1; 95% CI, 0.7–1.7). Infection with HIV-1 was associated with a 9.0-fold increased mortality risk (95% CI, 5.3–15.3). The incidence of diarrhea during the 2 years of follow-up was similar in formula and breastfeeding arms (155 vs 149 per 100 person-years, respectively). The incidence of pneumonia was identical in the 2 groups (62 per 100 person-years), and there were no significant differences in incidence of other recorded illnesses. Infants in the breastfeeding arm tended to have better nutritional status, significantly so during the first 6 months of life.</p></sec><sec id="S9"><title>Conclusions</title><p id="P9">In this randomized clinical trial, infants assigned to be formula fed or breastfed had similar mortality rates and incidence of diarrhea and pneumonia during the first 2 years of life. However, HIV-1–free survival at 2 years was significantly higher in the formula arm. With appropriate education and access to clean water, formula feeding can be a safe alternative to breastfeeding for infants of HIV-1–infected mothers in a resource-poor setting.</p></sec></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>
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<front><journal-meta><journal-id journal-id-type="nlm-journal-id">7501160</journal-id><journal-id journal-id-type="pubmed-jr-id">5346</journal-id><journal-id journal-id-type="nlm-ta">JAMA</journal-id><journal-id journal-id-type="iso-abbrev">JAMA</journal-id><journal-title-group><journal-title>Jama</journal-title></journal-title-group><issn pub-type="ppub">0098-7484</issn><issn pub-type="epub">1538-3598</issn></journal-meta><article-meta><article-id pub-id-type="pmid">11712936</article-id><article-id pub-id-type="pmc">3358136</article-id><article-id pub-id-type="manuscript">NIHMS359811</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Morbidity and Mortality in Breastfed and Formula-Fed Infants of HIV-1–Infected Women A Randomized Clinical Trial</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Mbori-Ngacha</surname><given-names>Dorothy</given-names></name><degrees>MBChB, MPH</degrees></contrib><aff id="A1">Department of Paediatrics, University of Nairobi, Nairobi, Kenya</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Nduati</surname><given-names>Ruth</given-names></name><degrees>MBChB, MPH</degrees></contrib><aff id="A2">Department of Paediatrics, University of Nairobi, Nairobi, Kenya</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>John</surname><given-names>Grace</given-names></name><degrees>MD, PhD</degrees></contrib><aff id="A3">Department of Medicine, University of Washington, Seattle</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Reilly</surname><given-names>Marie</given-names></name><degrees>PhD</degrees></contrib><aff id="A4">Department of Epidemiology and Public Health, University College, Cork, Ireland</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Richardson</surname><given-names>Barbra</given-names></name><degrees>PhD</degrees></contrib><aff id="A5">Department of Biostatistics, University of Washington, Seattle</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Mwatha</surname><given-names>Anthony</given-names></name><degrees>MS</degrees></contrib><aff id="A6">Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Ndinya-Achola</surname><given-names>Jeckoniah</given-names></name><degrees>MBChB</degrees></contrib></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Bwayo</surname><given-names>Job</given-names></name><degrees>PhD</degrees></contrib><aff id="A7">Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Kreiss</surname><given-names>Joan</given-names></name><degrees>MD, MSPH</degrees></contrib><aff id="A8">Department of Medicine, University of Washington, Seattle</aff><aff id="A9">Department of Epidemiology, University of Washington, Seattle</aff></contrib-group><author-notes><corresp id="CR1"><bold>Corresponding Author and Reprints:</bold> Joan Kreiss, MD, MSPH, Box 359931, 325 Ninth Ave, Seattle, WA 98104-2499 (<email>jkreiss@u.washington.edu</email>).</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>23</day><month>3</month><year>2012</year></pub-date><pub-date pub-type="ppub"><day>21</day><month>11</month><year>2001</year></pub-date><pub-date pub-type="pmc-release"><day>22</day><month>5</month><year>2012</year></pub-date><volume>286</volume><issue>19</issue><fpage>2413</fpage><lpage>2420</lpage><permissions><copyright-statement>©2001 American Medical Association. All rights reserved</copyright-statement><copyright-year>2001</copyright-year></permissions><abstract><sec id="S1"><title>Context</title><p id="P1">Breastfeeding among women infected with human immunodeficiency virus type 1 (HIV-1) is associated with substantial risk of HIV-1 transmission, but little is known about the morbidity risks associated with formula feeding in infants of HIV-1–infected women in resource-poor settings.</p></sec><sec id="S2"><title>Objective</title><p id="P2">To compare morbidity, nutritional status, mortality adjusted for HIV-1 status, and cause of death among formula-fed and breastfed infants of HIV-1–infected women.</p></sec><sec id="S3"><title>Design</title><p id="P3">Randomized clinical trial conducted between 1992 and 1998.</p></sec><sec id="S4"><title>Setting</title><p id="P4">Four antenatal clinics in Nairobi, Kenya.</p></sec><sec id="S5"><title>Participants</title><p id="P5">Of 401 live-born, singleton, or first-born twin infants of randomized HIV-1–seropositive mothers, 371 were included in the analysis of morbidity and mortality.</p></sec><sec id="S6"><title>Interventions</title><p id="P6">Mothers were randomly assigned either to use formula (n=186) or to breastfeed (n=185) their infants.</p></sec><sec id="S7"><title>Main Outcome Measures</title><p id="P7">Mortality rates, adjusted for HIV-1 infection status; morbidity; and nutritional status during the first 2 years of life.</p></sec><sec id="S8"><title>Results</title><p id="P8">Two-year estimated mortality rates among infants were similar in the formula-feeding and breastfeeding arms (20.0% vs 24.4%; hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.5–1.3), even after adjusting for HIV-1 infection status (HR, 1.1; 95% CI, 0.7–1.7). Infection with HIV-1 was associated with a 9.0-fold increased mortality risk (95% CI, 5.3–15.3). The incidence of diarrhea during the 2 years of follow-up was similar in formula and breastfeeding arms (155 vs 149 per 100 person-years, respectively). The incidence of pneumonia was identical in the 2 groups (62 per 100 person-years), and there were no significant differences in incidence of other recorded illnesses. Infants in the breastfeeding arm tended to have better nutritional status, significantly so during the first 6 months of life.</p></sec><sec id="S9"><title>Conclusions</title><p id="P9">In this randomized clinical trial, infants assigned to be formula fed or breastfed had similar mortality rates and incidence of diarrhea and pneumonia during the first 2 years of life. However, HIV-1–free survival at 2 years was significantly higher in the formula arm. With appropriate education and access to clean water, formula feeding can be a safe alternative to breastfeeding for infants of HIV-1–infected mothers in a resource-poor setting.</p></sec></abstract><funding-group><award-group><funding-source country="United States">National Institute of Child Health & Human Development : NICHD</funding-source><award-id>R01 HD023412-13 || HD</award-id></award-group><award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source><award-id>P30 AI027757-14 || AI</award-id></award-group><award-group><funding-source country="United States">Fogarty International Center : FIC</funding-source><award-id>D43 TW000007-12 || TW</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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