Early Weaning Increases Diarrhea Morbidity and Mortality Among Uninfected Children Born to HIV-infected Mothers in Zambia
Ashraf Fawzy,Stephen M. Arpadi,Chipepo Kankasa,Moses Sinkala,Mwiya Mwiya,Donald M. Thea,Grace M. Aldrovandi,Louise Kuhn +7 more
TLDR
In this article, the effects of early weaning on diarrhea morbidity and mortality of uninfected children born to HIV-infected mothers were evaluated in 618 HIV-uninfected singletons alive and still breastfeeding at 4 months.Abstract:
Background. Early weaning may reduce human immunodeficiency virus (HIV) transmission but may have deleterious consequences for uninfected children. Here we evaluate effects of early weaning on diarrhea morbidity and mortality of uninfected children born to HIV-infected mothers. Methods. HIV-infected women in Lusaka, Zambia, were randomly assigned to breastfeeding for 4 months only or to continue breastfeeding until the mother decided to stop. Replacement and complementary foods were provided and all women were counseled around feeding and hygiene. Diarrhea morbidity and mortality were assessed in 618 HIV-uninfected singletons alive and still breastfeeding at 4 months. Intent-to-treat analyses and comparisons based on actual feeding practices were conducted using regression methods. Results. Between 4 and 6 months, diarrheal episodes were 1.8-fold (95% confidence interval (CI), 1.3‐2.4) higher in the short compared with long breastfeeding group. Associations were stronger based on actual feeding practices and persisted after adjustment for confounding. At older ages, only more severe outcomes, including diarrhea-related hospitalization or death (relative hazard [RH], 3.2, 95% CI, 2.1‐5.1 increase 4‐24 months), were increased among weaned children. Conclusions. Continued breastfeeding is associated with reduced risk of diarrhea-related morbidity and mortality among uninfected children born to HIV-infected mothers in this low-resource setting despite provision of replacement and complementary food and counseling. Clinical Trials Registration. NCT00310726.read more
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L. Afran,L. Afran,M. Garcia Knight,M. Garcia Knight,Eunice Nduati,Britta C. Urban,Britta C. Urban,Robert S. Heyderman,Sarah Rowland-Jones +8 more
TL;DR: As the number of HEU children continues to increase worldwide, two questions with clear public health importance need to be addressed: first, does exposure to HIV‐1 and/or ART in utero or during infancy have direct immunological consequences, or are these poor outcomes simply attributable to the obvious disadvantages of being born into an HIV‐affected household?
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British HIV Association guidelines for the management of HIV infection in pregnant women 2012.
Graham P. Taylor,P Clayden,Jyoti Dhar,Kate Gandhi,Yvonne Gilleece,Kate Harding,P Hay,J Kennedy,Naomi Low-Beer,Hermione Lyall,Adrian Palfreeman,Pat A Tookey,Steven B. Welch,Edmund Wilkins,A de Ruiter +14 more
TL;DR: The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of human immunodeficiency virus (HIV)-positive pregnant women in the UK.
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