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Determining optimal breastfeeding in HIV affected resource-limited settings
Presented by Danstan Bagenda, Uganda.
Bagenda D.1
1Makerere University- Johns Hopkins University Research Collaboration (Kampala)/Johns Hopkins Fogarty (Baltimore), Kampala, Uganda
Objectives: To determine the breastfeeding pattern that minimizes age-specific mortality, morbidity, poor nutritional status and HIV infection of infants of HIV infected women that initiate breastfeeding in resource-limited settings.
Methods: Based on a population of HIV-infected mothers participating in two MTCT RCTs (PETRA - 1996-2000 and HIVIGLOB - 2004-2007) done at the same mother-child clinic in Kampala, Uganda, in periods with different global infant feeding recommendations and analyzed using a statistical approach that captures the dynamic aspects of each infants feeding and health characteristics using a multi-state markov-process type analysis.
Results: The biggest change in practice is the earlier cessation of breastfeeding, which has shortened from a median of 15.8 months (IQR: 12.2-18.7 months) for the PETRA study to 4.7 months (IQR: 3.3-6.4 months) for the HIVIGLOB study. After adjusting for confounding factors, the risk of death significantly increased by 20% per monthly decrease in breastfeeding duration. The frequency of transitioning from EBF directly to NBF is proportionately greater in the HIVIGLOB study than the PETRA study (31% vs 14%, p<0.05). A child that was ever mixed fed (MBF) had a 10-fold risk of HIV infection compared to one that was never MBF (95% CI 6.1-16.2, P<0.0001) with an an increase in risk observed with longer exposure to MBF. There is a two-fold increase of morbidity, especially at 3 months of age, corresponding to the point of average duration of EBF of both studies. Also, the higher the proportion of children that were still EBF, the lower the risk of undernutrition.
Conclusions: In order to minimize the risk of morbidity, undernutrition, mortality and HIV infection in children of HIV infected mothers in these settings, EBF should be practiced for at least 6 months and breastfeeding cessation be abrupt. Despite not meeting global recommendation criteria, mothers change infant feeding patterns, to the detriment of their children.
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