SidaSubSaharaV1, Ncbi, Checkpoint, bibRecord, 000532

Reduced Mortality Associated With Breast-Feeding–Acquired HIV Infection and Breast-Feeding Among HIV-Infected Children in Zambia

Identifieur interne : 000532 ( Ncbi/Checkpoint ); précédent : 000531; suivant : 000533

Reduced 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.

RBID : PMC:2814597

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.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814597

DOI: 10.1097/QAI.0b013e31816e39a3
PubMed: 18344878
PubMed Central: 2814597

Affiliations:

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PMC:2814597

Le document en format XML

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<p id="P1">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.</p>
</sec>
<sec id="S2"><title>Design</title>
<p id="P2">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).</p>
</sec>
<sec sec-type="methods" id="S3"><title>Methods</title>
<p id="P3">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).</p>
</sec>
<sec id="S4"><title>Results</title>
<p id="P4">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 (<italic>P</italic>
 = 0.001 and <italic>P</italic>
 = 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).</p>
</sec>
<sec id="S5"><title>Conclusions</title>
<p id="P5">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.</p>
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Le SIDA en Afrique subsaharienne (serveur d'exploration)

Reduced Mortality Associated With Breast-Feeding–Acquired HIV Infection and Breast-Feeding Among HIV-Infected Children in Zambia

Reduced Mortality Associated With Breast-Feeding–Acquired HIV Infection and Breast-Feeding Among HIV-Infected Children in Zambia

Source :

Abstract

Links toward previous steps (curation, corpus...)

Links to Exploration step

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

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Pour générer des pages wiki