Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study
Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study
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DOI：
10.1016/s0140-6736(99)01101-0
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发表时间：
1999-08-07
期刊：
影响因子：
168.9
通讯作者：
Coovadia, HM
中科院分区：
文献类型：
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作者：
Coutsoudis, A;Pillay, K;Coovadia, HM
鉴于艾滋病毒-1的母婴传播可能通过母乳喂养发生，因此制定了政策，建议发达国家和发展中国家在特定情况下避免感染艾滋病毒-1的妇女进行母乳喂养。我们比较了纯母乳喂养、混合喂养和配方喂养（从未母乳喂养）婴儿的传播率，以评估母乳喂养模式是否是HIV-1早期母婴传播的关键决定因素。方法我们前瞻性地评估了549名hiv -1感染妇女的婴儿喂养实践，这些妇女是南非德班维生素a干预试验的一部分。比较三个不同喂养组3个月时HIV-1感染婴儿的比例（使用Kaplan-Meier生命表估计），HIV-1感染通过RNA-PCR检测阳性来确定。在3个月时，156名从未母乳喂养的儿童中估计有18.8% （95% CI 12.6-24.9）感染了HIV-1，而393名母乳喂养的儿童中这一比例为21.3% (17.2-25.5)（p=0.5）。纯母乳喂养至3个月的婴儿HIV-1感染的估计比例（Kaplan-Meier）显著低于3个月前混合喂养的婴儿（14.6% [7.7-21.4]vs 24.1% [19.0-29.2], p=0.03）在调整潜在混杂因素（母体cd4细胞/ cd8细胞比例、梅毒筛查试验结果和早产）后，纯母乳喂养的HIV-1传播风险明显低于混合喂养（风险比0.52[0.28-0.98]），与不母乳喂养的风险相似（风险比0.85[0.51-1.42]）。我们的发现对发展中国家预防HIV-1感染和婴儿喂养政策具有重要意义，进一步的研究是必要的。与此同时，需要紧急审查针对感染艾滋病毒妇女的母乳喂养政策。如果我们的发现得到证实，纯母乳喂养可能为发展中国家感染艾滋病毒的妇女提供一种负担得起的、文化上可接受的有效手段，以减少艾滋病毒-1的母婴传播，同时保持母乳喂养的巨大好处。
Background The observation that mother-to-child transmission of HIV-1 can occur through breastfeeding has resulted in policies that recommend avoidance of breastfeeding by HIV-1-infected women in the developed world and under specific circumstances in developing countries. We compared transmission rates in exclusively breastfed, mixed-fed, and formula-fed (never breastfed) infants to assess whether the pattern of breastfeeding is a critical determinant of early mother-to-child transmission of HIV-1.Methods We prospectively assessed infant-feeding practices of 549 HIV-1-infected women who were part of a vitamin A intervention trial in Durban, South Africa. The proportions of HIV-1-infected infants at 3 months (estimated by use of Kaplan-Meier life tables) were compared in the three different feeding groups, HIV-1 infection was defined by a positive RNA-PCR test.Findings At 3 months, 18.8% (95% CI 12.6-24.9) of 156 never-breastfed children were estimated to be HIV-1 infected compared with 21.3% (17.2-25.5) of 393 breastfed children (p=0.5). The estimated proportion (Kaplan-Meier) of infants HIV-1 infected by 3 months was significantly lower for those exclusively breastfed to 3 months than in those who received mixed feeding before 3 months (14.6% [7.7-21.4] vs 24.1% [19.0-29.2], p=0.03) After adjustment for potential confounders (maternal CD4-cell/CD8-cell ratio, syphilis screening test results, and preterm delivery), exclusive breastfeeding carried a significantly lower risk of HIV-1 transmission than mixed feeding (hazard ratio 0.52 [0.28-0.98]) and a similar risk to no breastfeeding (0.85 [0.51-1.42]).Interpretations Our findings have important implications for prevention of HIV-1 infection and infant-feeding policies in developing countries and further research is essential. In the meantime, breastfeeding policies for HIV-l-infected women require urgent review. If our findings are confirmed, exclusive breastfeeding may offer HIV-l-infected women in developing countries an affordable, culturally acceptable, and effective means of reducing mother-to-child transmission of HIV-1 while maintaining the overwhelming benefits of breastfeeding.