BACKGROUND: Transmission of HIV-1 through breastfeeding is a major problem, although its timing is not well characterized. METHODS: The authors examined the timing and correlates of HIV-1 transmission through breastfeeding among 1078 HIV-infected pregnant women from Dar es Salaam, Tanzania enrolled in a trial to examine the effect of vitamin A and other vitamin supplements on mother-to-child transmission of HIV-1 and other health outcomes. Cumulative incidence was measured among children of women not randomized to vitamin A (n = 312), given the higher risk of infection observed among those in the vitamin A arm. For analyses of correlates, data from all children not infected by age 6 weeks were used (p = 659). RESULTS:Mean duration of breastfeeding was 20.3 months (SD = 4.4 months; median = 20.5 months). Thirty-seven infections were observed during 4372 child-months of follow-up evaluation, or 10.2 cases per 100 child-years. Infection risk by age 4 months was 3.8% (95% confidence interval [CI], 1.6%-6.1%) and increased to 17.9% (95% CI, 11.2%-24.5%) by age 24 months. In a multivariate proportional hazards model, high maternal viral load (p =.0001), low CD4 cell count (p =.004), and high maternal erythrocyte sedimentation rate (ESR; p=.004) were significant predictors of transmission of HIV-1 through breastfeeding. Mothers who had breast lesions during pregnancy were 2.00 times more likely to transmit the virus during breastfeeding than mothers without these lesions (95% CI, 1.29-3.08; p=.002). CONCLUSIONS: The rate of breastfeeding transmission of HIV-1 is high, and early weaning is likely to be associated with reduced transmission. Antiretroviral drugs given to HIV-infected mothers are likely to reduce the risk of breastfeeding transmission. In their absence, interventions that enhance immune reconstitution, such as micronutrient supplements, may be beneficial against transmission. Methods to prevent and treat nipple cracks and mastitis may also be important.
RCT Entities:
BACKGROUND: Transmission of HIV-1 through breastfeeding is a major problem, although its timing is not well characterized. METHODS: The authors examined the timing and correlates of HIV-1 transmission through breastfeeding among 1078 HIV-infected pregnant women from Dar es Salaam, Tanzania enrolled in a trial to examine the effect of vitamin A and other vitamin supplements on mother-to-child transmission of HIV-1 and other health outcomes. Cumulative incidence was measured among children of women not randomized to vitamin A (n = 312), given the higher risk of infection observed among those in the vitamin A arm. For analyses of correlates, data from all children not infected by age 6 weeks were used (p = 659). RESULTS: Mean duration of breastfeeding was 20.3 months (SD = 4.4 months; median = 20.5 months). Thirty-seven infections were observed during 4372 child-months of follow-up evaluation, or 10.2 cases per 100 child-years. Infection risk by age 4 months was 3.8% (95% confidence interval [CI], 1.6%-6.1%) and increased to 17.9% (95% CI, 11.2%-24.5%) by age 24 months. In a multivariate proportional hazards model, high maternal viral load (p =.0001), low CD4 cell count (p =.004), and high maternal erythrocyte sedimentation rate (ESR; p=.004) were significant predictors of transmission of HIV-1 through breastfeeding. Mothers who had breast lesions during pregnancy were 2.00 times more likely to transmit the virus during breastfeeding than mothers without these lesions (95% CI, 1.29-3.08; p=.002). CONCLUSIONS: The rate of breastfeeding transmission of HIV-1 is high, and early weaning is likely to be associated with reduced transmission. Antiretroviral drugs given to HIV-infected mothers are likely to reduce the risk of breastfeeding transmission. In their absence, interventions that enhance immune reconstitution, such as micronutrient supplements, may be beneficial against transmission. Methods to prevent and treat nipple cracks and mastitis may also be important.
Authors: Valerie L Flax; Margaret E Bentley; Charles S Chasela; Dumbani Kayira; Michael G Hudgens; Rodney J Knight; Alice Soko; Denise J Jamieson; Charles M van der Horst; Linda S Adair Journal: J Nutr Date: 2012-05-30 Impact factor: 4.798
Authors: Caitlin M Dugdale; Andrea L Ciaranello; Linda-Gail Bekker; Madeline E Stern; Landon Myer; Robin Wood; Paul E Sax; Elaine J Abrams; Kenneth A Freedberg; Rochelle P Walensky Journal: Ann Intern Med Date: 2019-04-02 Impact factor: 25.391
Authors: Charles van der Horst; Charles Chasela; Yusuf Ahmed; Irving Hoffman; Mina Hosseinipour; Rodney Knight; Susan Fiscus; Michael Hudgens; Peter Kazembe; Margaret Bentley; Linda Adair; Ellen Piwoz; Francis Martinson; Ann Duerr; Athena Kourtis; A Edde Loeliger; Beth Tohill; Sascha Ellington; Denise Jamieson Journal: Contemp Clin Trials Date: 2008-09-07 Impact factor: 2.226
Authors: Katherine Semrau; Louise Kuhn; Daniel R Brooks; Howard Cabral; Moses Sinkala; Chipepo Kankasa; Donald M Thea; Grace M Aldrovandi Journal: Am J Obstet Gynecol Date: 2011-06-15 Impact factor: 8.661
Authors: A E Ezeamama; C Duggan; K P Manji; D Spiegelman; E Hertzmark; R J Bosch; R Kupka; J O Okuma; R Kisenge; S Aboud; W W Fawzi Journal: HIV Med Date: 2013-11-11 Impact factor: 3.180
Authors: Andrea L Ciaranello; George R Seage; Kenneth A Freedberg; Milton C Weinstein; Shahin Lockman; Rochelle P Walensky Journal: AIDS Date: 2008-11-12 Impact factor: 4.177