Elevations in Mortality Associated with Weaning Persist into the Second Year of Life among Uninfected Children Born to HIV-Infected Mothers
Elevations in Mortality Associated with Weaning Persist into the Second Year of Life among Uninfected Children Born to HIV-Infected Mothers
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DOI：
10.1086/649886
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发表时间：
2010-02-01
影响因子：
11.8
通讯作者：
Aldrovandi, Grace M.
中科院分区：
文献类型：
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作者：
Kuhn, Louise;Sinkala, Moses;Aldrovandi, Grace M.
背景早期断奶被建议减少产后人体免疫缺陷病毒（艾滋病毒）的传播。我们评估了在不同年龄停止母乳喂养对HIV感染母亲所生未感染儿童死亡率的安全性。在赞比亚卢萨卡进行的一项早期断奶试验中，招募了958名感染艾滋病毒的母亲及其婴儿，并从出生到产后24个月进行随访。队列中的一半随机在4个月时突然断奶，另一半随机继续母乳喂养。我们研究了未感染儿童死亡率和实际母乳喂养时间之间的关系，并调查了可能的混杂因素和效应修正。749名未受感染儿童的死亡率在12个月大时为9.4%，在24个月大时为13.6%。在方案鼓励的间期内撤机（4-5个月）与死亡风险增加2.03倍相关（95%置信区间[CI]，1.13-3.65），6-11月龄断奶与3.54倍增加相关（95% CI，1.68-7.46），12-18月龄断奶与4.22倍增加相关（95% CI，1.59-11.24）。检测到显著的效应修正，例如，在CD 4（+）细胞计数较高（1350个细胞/μ L）的母亲所生的婴儿中，与断奶相关的风险更大。如果缩短生活在资源匮乏环境中的艾滋病毒感染母亲所生未感染儿童的正常母乳喂养时间，则会导致生命第二年的死亡率大幅上升。密集的营养和咨询干预减少但不能消除这种过度死亡率。
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 (1350 cells/mu L).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.