Early Infant Feeding Patterns and HIV-free Survival Findings from the Kesho-Bora Trial (Burkina Faso, Kenya, South Africa)
Early Infant Feeding Patterns and HIV-free Survival Findings from the Kesho-Bora Trial (Burkina Faso, Kenya, South Africa)
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DOI：
10.1097/inf.0000000000000512
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发表时间：
2015-02-01
影响因子：
3.6
通讯作者：
Bork, Kirsten
中科院分区：
文献类型：
--
作者：
Cournil, Amandine;Van de Perre, Philippe;Bork, Kirsten
目的：调查喂养方式与HIV感染母亲所生儿童的无HIV存活率之间的关系，并阐明抗逆转录病毒（ARV）预防是否改变了这种关系。方法：从2005年6月至2008年8月，向感染艾滋病毒的孕妇提供了有关婴儿喂养选择的咨询，并随机分配到三联抗逆转录病毒药物预防（三联抗逆转录病毒药物），直到6个月前停止母乳喂养（BFC）或产前齐多夫定与单剂量奈韦拉平（短程抗逆转录病毒药物）。通过喂养模式（从出生起替代喂养，BFC = 3个月）评估2周龄时HIV阴性婴儿18个月的无HIV存活率。结果：在753名存活且2周时HIV阴性的婴儿中，28名获得性感染，47名在18个月时死亡。18个月时的总体无HIV生存率为0.91 [95%置信区间（CI）：0.88-0.93]。在短期抗逆转录病毒治疗组中，无艾滋病毒生存率（0.88; CI：0.84-0.91）没有因喂养方式而异。在三联抗逆转录病毒治疗组中，总体无艾滋病毒生存率为0.93（CI：0.90-0.95），BFC = 3个月（校正风险比：0.36; CI：0.15-0.83）和替代喂养（校正风险比：0.20; CI：0.04-0.94）。在三重抗逆转录病毒治疗组中，9例中有4例发生在报告BFC后（19例中有5例发生在短期治疗组），这表明一些妇女在中断抗逆转录病毒预防治疗后继续母乳喂养。结论：在资源有限的环境中，早期断奶以前与较高的婴儿死亡率相关。我们发现，即使在母乳喂养期间进行了三重抗逆转录病毒药物预防，早期断奶仍然与较低的无艾滋病毒生存率相关，特别是死亡率增加。
Objective: To investigate the association between feeding patterns and HIV-free survival in children born to HIV-infected mothers and to clarify whether antiretroviral (ARV) prophylaxis modifies the association.Methods: From June 2005 to August 2008, HIV-infected pregnant women were counseled regarding infant feeding options, and randomly assigned to triple-ARV prophylaxis (triple ARV) until breastfeeding cessation (BFC) before age 6 months or antenatal zidovudine with single-dose nevirapine (short-course ARV). Eighteen-month HIV-free survival of infants HIV-negative at 2 weeks of age was assessed by feeding patterns (replacement feeding from birth, BFC = 3 months).Results: Of the 753 infants alive and HIV-negative at 2 weeks, 28 acquired infection and 47 died by 18 months. Overall HIV-free survival at 18 months was 0.91 [95% confidence interval (CI): 0.88-0.93]. In the short-course ARV arm, HIV-free survival (0.88; CI: 0.84-0.91) did not differ by feeding patterns. In the triple ARV arm, overall HIV-free survival was 0.93 (CI: 0.90-0.95) and BFC = 3 months (adjusted hazard ratio: 0.36; CI: 0.15-0.83) and replacement feeding (adjusted hazard ratio: 0.20; CI: 0.04-0.94). In the triple ARV arm, 4 of 9 transmissions occurred after reported BFC (and 5 of 19 in the short-course arm), indicating that some women continued breastfeeding after interruption of ARV prophylaxis.Conclusions: In resource-constrained settings, early weaning has previously been associated with higher infant mortality. We show that, even with maternal triple-ARV prophylaxis during breastfeeding, early weaning remains associated with lower HIV-free survival, driven in particular by increased mortality.