Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 mo of life : the Kesho Bora study

2014

Article référencé dans le Web of Science WOS:000345267600019

Bork Kirsten, Cournil Amandine, Read J. S., Newell M. L., Cames Cécile, Meda N., Luchters S., Mbatia G., Naidu K., Gaillard P., de Vincenzi I.

American Journal of Clinical Nutrition, 2014, 100 (6), p. 1559-1568 ISSN 0002-9165

Background: Refraining from breastfeeding to prevent HIV transmission has been associated with increased morbidity and mortality in HIV-exposed African infants. Objective: The objective was to assess risks of common and serious infectious morbidity by feeding mode in HIV-exposed, uninfected infants <= 6 mo of age with special attention to the issue of reverse causality. Design: HIV-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the prevention of mother-to-child transmission Kesho Bora trial and counseled to either breastfeed exclusively and cease by 6 mo postpartum or formula feed exclusively. Maternal-reported morbidity (fever, diarrhea, and vomiting) and serious infectious events (SIEs) (gastroenteritis and lower respiratory tract infections) were investigated for 751 infants for 2 age periods (0-2.9 and 3-6 mo) by using generalized linear mixed models with breastfeeding as a time-dependent variable and adjustment for study site, maternal education, economic level, and cotrimoxazole prophylaxis. Results: Reported morbidity was not significantly higher in non-breastfed compared with breastfed infants [OR: 1.31 (95% CI: 0.97, 1.75) and 1.21 (0.90, 1.62) at 0-2.9 and 3-6 mo of age, respectively]. Between 0 and 2.9 mo of age, never-breastfed infants had increased risks of morbidity compared with those of infants who were exclusively breastfed (OR: 1.49; 95% CI: 1.01, 2.2; P = 0.042). The adjusted excess risk of SIEs in nonbreastfed infants was large between 0 and 2.9 mo (OR: 6.0; 95% CI: 2.2, 16.4; P = 0.001). Between 3 and 6 mo, the OR for SIEs was sensitive to the timing of breastfeeding status, i.e., 4.3 (95% CI: 1.2, 15.3; P = 0.02) when defined at end of monthly intervals and 2.0 (95% CI: 0.8, 5.0; P = 0.13) when defined at the beginning of intervals. Of 52 SIEs, 3 mothers reported changes in feeding mode during the SW although none of the mothers ceased breastfeeding completely. Conclusions: Not breastfeeding was associated with increased risk of serious infections especially between 0 and 2.9 mo of age.

Entomologie médicale / Parasitologie / Virologie [052] ; Nutrition, alimentation [054]

BURKINA FASO ; KENYA ; AFRIQUE DU SUD

Fonds IRD [F B010062722]

fdi:010062722