Infant feeding, HIV transmission and mortality at 18 months: the need for appropriate choices by mothers and prioritization within programmes
Infant feeding, HIV transmission and mortality at 18 months: the need for appropriate choices by mothers and prioritization within programmes
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DOI：
10.1097/qad.0b013e328312c740
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发表时间：
2008-11-12
期刊：
影响因子：
3.8
通讯作者：
Newell, Marie-Louise
中科院分区：
文献类型：
--
作者：
Rollins, Nigel C.;Becquet, Renaud;Newell, Marie-Louise
目的：确定与婴儿早期喂养方式相关的艾滋病病毒（HIV）晚期传播及生存风险。
设计：一个非随机干预队列。
方法：在婴儿喂养选择方面为感染HIV的孕妇提供支持。每周获取婴儿喂养数据；每月采集婴儿血液样本以诊断HIV感染。根据6个月时的婴儿喂养方式评估18个月的死亡率和HIV传播风险。
结果：纳入1193名活产婴儿。未感染HIV和感染HIV的儿童18个月的总体死亡概率（95%置信区间）分别为0.04（0.03 - 0.06）和0.53（0.46 - 0.60）。对于出生后母乳喂养或替代喂养的未感染HIV的婴儿，18个月的生存概率在统计学上无显著差异。在对婴儿喂养方式的单变量分析中，6个月时存活的儿童在出生后6个月后的无HIV生存概率在出生后采用替代喂养的婴儿中为0.98（0.89 - 1.00），母乳喂养少于6个月和多于6个月的婴儿分别为0.96（0.90 - 0.98；P = 0.25）和0.91（0.87 - 0.94；P = 0.03）。在多变量分析中，母亲失业和产前CD4细胞计数低与婴儿感染HIV或死亡的风险增加三倍以上独立相关。
结论：未感染HIV的婴儿母乳喂养和替代喂养在18个月时的死亡率相似。然而，这些结果是在母亲和婴儿得到良好支持以首先做出并实践适当的婴儿喂养选择的情况下得出的。为使相关项目取得类似结果，咨询质量以及对CD4细胞计数低的母亲的识别需要成为改进策略的目标。（C）2008年威科集团健康部门 | 利平科特·威廉姆斯和威尔金斯出版社
Objectives: To determine the late HIV transmission and survival risks associated with early infant feeding practices.Design: A nonrandomized intervention cohort.Methods: HIV-infected pregnant women were supported in their infant feeding choices. Infant feeding data were obtained weekly; blood samples from infants were taken monthly to diagnose HIV infection. Eighteen-month mortality and HIV transmission risk were assessed according to infant feeding practices at 6 months.Results: One thousand one hundred and ninety-three live-born infants were included. Overall 18-month probabilities of death (95% confidence interval) were 0.04 (0.03-0.06) and 0.53 (0.46-0.60) for HIV-uninfected and HIV-infected children, respectively. The eighteen-month probability of survival was not statistically significantly different for HIV-uninfected infants breastfed or replacement fed from birth. In univariate analysis of infant feeding practices, the probability of HIV-free survival beyond the first 6 months of life in children alive at 6 months was 0.98 (0.89-1.00) amongst infants replacement fed from birth, 0.96 (0.90-0.98; P = 0.25) and 0.91 (0.87-0.94; P = 0.03) in those breastfed for less or more than 6 months, respectively. In multivariable analyses, maternal unemployment and low antenatal CD4 cell count were independently associated with more than three-fold increased risk of infant HIV infection or death.Conclusion: Breastfeeding and replacement feeding of HIV-uninfected infants were associated with similar mortality rates at 18 months. However, these findings were amongst mothers and infants who received excellent support to first make, and then practice, appropriate infant feeding choices. For programmes to achieve similar results, the quality of counselling and identification of mothers with low CD4 cell count need to be the targets of improvement strategies. (C) 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins