BACKGROUND: In low-resource settings, many programs recommend that women who are infected with the human immunodeficiency virus (HIV) stop breast-feeding early. We conducted a randomized trial to evaluate whether abrupt weaning at 4 months as compared with the standard practice has a net benefit for HIV-free survival of children. METHODS: We enrolled 958 HIV-infected women and their infants in Lusaka, Zambia. All the women planned to breast-feed exclusively to 4 months; 481 were randomly assigned to a counseling program that encouraged abrupt weaning at 4 months, and 477 to a program that encouraged continued breast-feeding for as long as the women chose. The primary outcome was either HIV infection or death of the child by 24 months. RESULTS: In the intervention group, 69.0% of the mothers stopped breast-feeding at 5 months or earlier; 68.8% of these women reported the completion of weaning in less than 2 days. In the control group, the median duration of breast-feeding was 16 months. In the overall cohort, there was no significant difference between the groups in the rate of HIV-free survival among the children; 68.4% and 64.0% survived to 24 months without HIV infection in the intervention and control groups, respectively (P=0.13). Among infants who were still being breast-fed and were not infected with HIV at 4 months, there was no significant difference between the groups in HIV-free survival at 24 months (83.9% and 80.7% in the intervention and control groups, respectively; P=0.27). Children who were infected with HIV by 4 months had a higher mortality by 24 months if they had been assigned to the intervention group than if they had been assigned to the control group (73.6% vs. 54.8%, P=0.007). CONCLUSIONS: Early, abrupt cessation of breast-feeding by HIV-infected women in a low-resource setting, such as Lusaka, Zambia, does not improve the rate of HIV-free survival among children born to HIV-infected mothers and is harmful to HIV-infected infants.(ClinicalTrials.gov number, NCT00310726.) 2008 Massachusetts Medical Society
RCT Entities:
BACKGROUND: In low-resource settings, many programs recommend that women who are infected with the human immunodeficiency virus (HIV) stop breast-feeding early. We conducted a randomized trial to evaluate whether abrupt weaning at 4 months as compared with the standard practice has a net benefit for HIV-free survival of children. METHODS: We enrolled 958 HIV-infectedwomen and their infants in Lusaka, Zambia. All the women planned to breast-feed exclusively to 4 months; 481 were randomly assigned to a counseling program that encouraged abrupt weaning at 4 months, and 477 to a program that encouraged continued breast-feeding for as long as the women chose. The primary outcome was either HIV infection or death of the child by 24 months. RESULTS: In the intervention group, 69.0% of the mothers stopped breast-feeding at 5 months or earlier; 68.8% of these women reported the completion of weaning in less than 2 days. In the control group, the median duration of breast-feeding was 16 months. In the overall cohort, there was no significant difference between the groups in the rate of HIV-free survival among the children; 68.4% and 64.0% survived to 24 months without HIV infection in the intervention and control groups, respectively (P=0.13). Among infants who were still being breast-fed and were not infected with HIV at 4 months, there was no significant difference between the groups in HIV-free survival at 24 months (83.9% and 80.7% in the intervention and control groups, respectively; P=0.27). Children who were infected with HIV by 4 months had a higher mortality by 24 months if they had been assigned to the intervention group than if they had been assigned to the control group (73.6% vs. 54.8%, P=0.007). CONCLUSIONS: Early, abrupt cessation of breast-feeding by HIV-infectedwomen in a low-resource setting, such as Lusaka, Zambia, does not improve the rate of HIV-free survival among children born to HIV-infected mothers and is harmful to HIV-infectedinfants.(ClinicalTrials.gov number, NCT00310726.) 2008 Massachusetts Medical Society
Authors: R Nduati; G John; D Mbori-Ngacha; B Richardson; J Overbaugh; A Mwatha; J Ndinya-Achola; J Bwayo; F E Onyango; J Hughes; J Kreiss Journal: JAMA Date: 2000-03-01 Impact factor: 56.272
Authors: D Mbori-Ngacha; R Nduati; G John; M Reilly; B Richardson; A Mwatha; J Ndinya-Achola; J Bwayo; J Kreiss Journal: JAMA Date: 2001-11-21 Impact factor: 56.272
Authors: Elizabeth M Stringer; Moses Sinkala; Jeffrey S Stringer; Elizabeth Mzyece; Ida Makuka; Robert L Goldenberg; Pascal Kwape; Martha Chilufya; Sten H Vermund Journal: AIDS Date: 2003-06-13 Impact factor: 4.177
Authors: Denise J Jamieson; Charles S Chasela; Michael G Hudgens; Caroline C King; Athena P Kourtis; Dumbani Kayira; Mina C Hosseinipour; Deborah D Kamwendo; Sascha R Ellington; Jeffrey B Wiener; Susan A Fiscus; Gerald Tegha; Innocent A Mofolo; Dorothy S Sichali; Linda S Adair; Rodney J Knight; Francis Martinson; Zebrone Kacheche; Alice Soko; Irving Hoffman; Charles van der Horst Journal: Lancet Date: 2012-04-26 Impact factor: 79.321
Authors: Katherine C Liu; Jessica Mulindwa; Mark J Giganti; Nande B Putta; Namwinga Chintu; Benjamin H Chi; Jeffrey S A Stringer; Elizabeth M Stringer Journal: J Acquir Immune Defic Syndr Date: 2011-08-15 Impact factor: 3.731