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Medline ® Abstract for Reference 98

of 'Prevention of HIV transmission during breastfeeding in resource-limited settings'

Breastfeeding, mother-to-child HIV transmission, and mortality among infants born to HIV-Infected women on highly active antiretroviral therapy in rural Uganda.
Homsy J, Moore D, Barasa A, Were W, Likicho C, Waiswa B, Downing R, Malamba S, Tappero J, Mermin J
J Acquir Immune Defic Syndr. 2010;53(1):28.
BACKGROUND: Highly active antiretroviral therapy (HAART) drastically reduces mother-to-child transmission of HIV, but where breastfeeding is the only safe infant feeding option, HAART for the prevention of mother-to-child transmission needs to be evaluated in relation to both HIV transmission and infant mortality.
DESIGN AND METHODS: One hundred and two>or = 18-year old women on HAART in rural Uganda who delivered one or more live infants between March 1, 2003 and January 1, 2007 were enrolled in a prospective study to assess HIV transmission and infant survival. All pregnant women were counseled to exclusively breastfeed for 3-6 months according to national guidelines at the time. Infants were followed-up for>or = 7 months and were offered HIV polymerase chain reaction testing quarterly from 6 weeks of age until>or = 6 weeks after complete weaning.
RESULTS: Of 118 infants born during follow-up, 109 (92%) were breastfed. Median durations of exclusive and total breastfeeding were 4 months (interquartile range 3-6) and 5 months (interquartile range 3-7), respectively. None of the infants tested HIV polymerase chain reaction positive over follow-up but 16 infants died without a definitive HIV status at a median age of 2.6 months. In total, 23 (19%) infants died during follow-up at a median age of 3.7 months; 15 (65%) of whom with severe diarrhea and/or vomiting in the week preceding their death. In multivariate analysis, there was a 6-fold greater risk of death among infants breastfed for less than 6 months independent of maternal CD4 count closest to delivery, maternal marital status or maternal death (adjusted hazard ratio = 6.19; 95% confidence interval 1.41-27.0, P = 0.015).
CONCLUSIONS: In resource-constrained settings, HIV-infected pregnant women should be assessed for HAART eligibility and treated as needed without delay, and should be encouraged to breastfeed their infants for at least 6 months.
Institute for Global Health, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94105, USA. jhomsy@psg.ucsf.edu