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Clin Infect Dis. 2010 Feb 1;50(3):437-44. doi: 10.1086/649886.

Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-infected mothers.

Author information

1
Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Departments of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA. lk24@columbia.edu

Abstract

BACKGROUND:

Early weaning has been recommended to reduce postnatal human immunodeficiency virus (HIV) transmission. We evaluated the safety of stopping breast-feeding at different ages for mortality of uninfected children born to HIV-infected mothers.

METHODS:

During a trial of early weaning, 958 HIV-infected mothers and their infants were recruited and followed up from birth to 24 months postpartum in Lusaka, Zambia. One-half of the cohort was randomized to wean abruptly at 4 months, and the other half of the cohort was randomized to continue breast-feeding. We examined associations between uninfected child mortality and actual breast-feeding duration and investigated possible confounding and effect modification.

RESULTS:

The mortality rate among 749 uninfected children was 9.4% by 12 months of age and 13.6% by 24 months of age. Weaning during the interval encouraged by the protocol (4-5 months of age) was associated with a 2.03-fold increased risk of mortality (95% confidence interval [CI], 1.13-3.65), weaning at 6-11 months of age was associated with a 3.54-fold increase (95% CI, 1.68-7.46), and weaning at 12-18 months of age was associated with a 4.22-fold increase (95% CI, 1.59-11.24). Significant effect modification was detected, such that risks associated with weaning were stronger among infants born to mothers with higher CD4(+) cell counts (>350 cells/microL).

CONCLUSION:

Shortening the normal duration of breast-feeding for uninfected children born to HIV-infected mothers living in low-resource settings is associated with significant increases in mortality extending into the second year of life. Intensive nutritional and counseling interventions reduce but do not eliminate this excess mortality.

PMID:
20047479
PMCID:
PMC2805776
DOI:
10.1086/649886
[Indexed for MEDLINE]
Free PMC Article

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