Reduced Mortality Associated With Breast-Feeding-Acquired HIV Infection and Breast-Feeding Among HIV-Infected Children in Zambia
Identifieur interne : 006429 ( Main/Merge ); précédent : 006428; suivant : 006430Reduced Mortality Associated With Breast-Feeding-Acquired HIV Infection and Breast-Feeding Among HIV-Infected Children in Zambia
Auteurs : Matthew P. Fox [États-Unis] ; Daniel Brooks [États-Unis] ; Louise Kuhn [États-Unis] ; Grace Aldrovandi [États-Unis] ; Moses Sinkala [Zambie] ; Chipepo Kankasa [Zambie] ; Mwiya Mwiya [Zambie] ; Robert Horsburgh [États-Unis] ; Donald M. Thea [États-Unis]Source :
- Journal of acquired immune deficiency syndromes : (1999) [ 1525-4135 ] ; 2008.
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Abstract
Objectives: In developing countries, where mother-to-child transmission of HIV through breast-feeding is common, little is known about the impact of postpartum transmission on child survival. This study assessed whether children infected postpartum have longer survival from time of infection versus those infected during gestation or delivery. Design: We used a prospective cohort study to analyze data from 213 HIV-infected children enrolled in a breast-feeding intervention trial in Lusaka, Zambia (2001 to 2004). Methods: We compared mortality 1 year after HIV infection in children stratified by age of infection: 0 to 3 days (intrauterine [IU] group), 4 to 40 days (intrapartum/early postpartum [IP/EPP] group), and >40 days (postpartum [PP] group). Results: A total of 61, 71, and 81 children were infected in the IU, IP/EPP, and PP groups, respectively. Children with intrauterine or intrapartum/early postpartum transmission had higher mortality over the first 12 months after infection than children with postpartum transmission (P = 0.001 and P = 0.006, respectively); no differences were detected between children with intrauterine and intrapartum/ early postpartum transmission. Nearly 20% of the IU and IP/EPP groups died by 100 days after infection, whereas nearly 10% of the PP group had died by this time. After adjusting for birth weight, maternal CD4 cell count, breast-feeding, and maternal death, children infected postpartum had one quarter the mortality rate (hazard ratio [HR] = 0.27, 95% confidence interval [CI]: 0.15 to 0.50) of those infected in utero. Stopping breast-feeding increased mortality in infected children (HR = 3.1, 95% CI: 1.8 to 5.3). Conclusions: This study demonstrates a survival benefit among children infected postpartum versus children infected during pregnancy or delivery and a benefit to increased breast-feeding duration among infected children. Testing children for HIV early may provide a means to allow for earlier intervention.
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<series><title level="j" type="main">Journal of acquired immune deficiency syndromes : (1999)</title>
<title level="j" type="abbreviated">J. acquir. immune defic. syndr. : (1999)</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term>
<term>Breast feeding</term>
<term>Child</term>
<term>Human immunodeficiency virus</term>
<term>Infant</term>
<term>Microbiology</term>
<term>Vertical transmission</term>
<term>Virology</term>
<term>Zambia</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Virus immunodéficience humaine</term>
<term>Allaitement</term>
<term>Enfant</term>
<term>Zambie</term>
<term>Nourrisson</term>
<term>Transmission verticale</term>
<term>Microbiologie</term>
<term>Virologie</term>
<term>SIDA</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Zambie</term>
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<front><div type="abstract" xml:lang="en">Objectives: In developing countries, where mother-to-child transmission of HIV through breast-feeding is common, little is known about the impact of postpartum transmission on child survival. This study assessed whether children infected postpartum have longer survival from time of infection versus those infected during gestation or delivery. Design: We used a prospective cohort study to analyze data from 213 HIV-infected children enrolled in a breast-feeding intervention trial in Lusaka, Zambia (2001 to 2004). Methods: We compared mortality 1 year after HIV infection in children stratified by age of infection: 0 to 3 days (intrauterine [IU] group), 4 to 40 days (intrapartum/early postpartum [IP/EPP] group), and >40 days (postpartum [PP] group). Results: A total of 61, 71, and 81 children were infected in the IU, IP/EPP, and PP groups, respectively. Children with intrauterine or intrapartum/early postpartum transmission had higher mortality over the first 12 months after infection than children with postpartum transmission (P = 0.001 and P = 0.006, respectively); no differences were detected between children with intrauterine and intrapartum/ early postpartum transmission. Nearly 20% of the IU and IP/EPP groups died by 100 days after infection, whereas nearly 10% of the PP group had died by this time. After adjusting for birth weight, maternal CD4 cell count, breast-feeding, and maternal death, children infected postpartum had one quarter the mortality rate (hazard ratio [HR] = 0.27, 95% confidence interval [CI]: 0.15 to 0.50) of those infected in utero. Stopping breast-feeding increased mortality in infected children (HR = 3.1, 95% CI: 1.8 to 5.3). Conclusions: This study demonstrates a survival benefit among children infected postpartum versus children infected during pregnancy or delivery and a benefit to increased breast-feeding duration among infected children. Testing children for HIV early may provide a means to allow for earlier intervention.</div>
</front>
</TEI>
<affiliations><list><country><li>Zambie</li>
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<tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Fox, Matthew P" sort="Fox, Matthew P" uniqKey="Fox M" first="Matthew P." last="Fox">Matthew P. Fox</name>
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<name sortKey="Aldrovandi, Grace" sort="Aldrovandi, Grace" uniqKey="Aldrovandi G" first="Grace" last="Aldrovandi">Grace Aldrovandi</name>
<name sortKey="Brooks, Daniel" sort="Brooks, Daniel" uniqKey="Brooks D" first="Daniel" last="Brooks">Daniel Brooks</name>
<name sortKey="Horsburgh, Robert" sort="Horsburgh, Robert" uniqKey="Horsburgh R" first="Robert" last="Horsburgh">Robert Horsburgh</name>
<name sortKey="Kuhn, Louise" sort="Kuhn, Louise" uniqKey="Kuhn L" first="Louise" last="Kuhn">Louise Kuhn</name>
<name sortKey="Thea, Donald M" sort="Thea, Donald M" uniqKey="Thea D" first="Donald M." last="Thea">Donald M. Thea</name>
</country>
<country name="Zambie"><noRegion><name sortKey="Sinkala, Moses" sort="Sinkala, Moses" uniqKey="Sinkala M" first="Moses" last="Sinkala">Moses Sinkala</name>
</noRegion>
<name sortKey="Kankasa, Chipepo" sort="Kankasa, Chipepo" uniqKey="Kankasa C" first="Chipepo" last="Kankasa">Chipepo Kankasa</name>
<name sortKey="Mwiya, Mwiya" sort="Mwiya, Mwiya" uniqKey="Mwiya M" first="Mwiya" last="Mwiya">Mwiya Mwiya</name>
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