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J Acquir Immune Defic Syndr. 2014 Jun 1;66(2):181-7. doi: 10.1097/QAI.0000000000000150.

Growth and HIV-free survival of HIV-exposed infants in Malawi: a randomized trial of two complementary feeding interventions in the context of maternal antiretroviral therapy.

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Departments of *Community Health; †Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi; ‡Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland; and §Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110.



To compare the growth of HIV-exposed children receiving 1 of 2 complementary foods after prevention of mother-to-child HIV transmission through maternal lifelong antiretroviral therapy (ART).


In rural Malawi, 280 HIV-infected pregnant women were consecutively identified and offered ART, without consideration of their CD4 counts. Mothers were supported to exclusively breast-feed and children tested for HIV status at 1.5 and 5.5 months of age. From this group, 248 HIV-exposed children were enrolled and randomized to receive micronutrients with either whole milk powder or a ready-to-use complementary food (RUF), until the child reached 12 months of age. Children were followed until 18 months of age.


HIV-free survival at 12 months was 90% (95% confidence interval: 87% to 94%). Exclusive breast-feeding for the first 6 months of life was practiced in 97% of the children. At 12 months of age, 89% of the children continued to be breast-fed. At 6 months of age, infants had a weight-for-height z score of 0.7 ± 1.1 (mean ± SD) and length-for-age z score of -1.3 ± 1.2. The decrease in length-for-age z score among children receiving RUF at 12 months of age was greater than that seen in those receiving milk powder (-0.3 ± 0.8 vs -0.1 ± 0.7, P = 0.04). Mean weight-for-height z score was >0 at 12 and 18 months of age in both groups.


HIV-free survival ≥90% at 12 months was achieved with maternal ART while either milk powder or RUF as a complementary food preserved child anthropometry. Breast-feeding by mothers receiving ART was acceptable.

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