%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Cournil, Amandine
%A Van de Perre, P.
%A Cames, Cécile
%A de Vincenzi, I.
%A Read, J. S.
%A Luchters, S.
%A Meda, N.
%A Naidu, K.
%A Newell, M. L.
%A Bork, Kirsten
%T Early infant feeding patterns and HIV-free survival findings from the Kesho-Bora trial (Burkina Faso, Kenya, South Africa)
%D 2015
%L fdi:010063966
%G ENG
%J Pediatric Infectious Disease Journal
%@ 0891-3668
%K infant ; HIV-free survival ; prevention of mother-to-child transmission ; breastfeeding ; antiretroviral therapy ; Africa
%K BURKINA FASO ; KENYA ; AFRIQUE DU SUD
%M ISI:000349908800013
%N 2
%P 168-174
%R 10.1097/inf.0000000000000512
%U https://www.documentation.ird.fr/hor/fdi:010063966
%> https://www.documentation.ird.fr/intranet/publi/2015/04/010063966.pdf
%V 34
%W Horizon (IRD)
%X Objective: To investigate the association between feeding patterns and HIV-free survival in children born to HIV-infected mothers and to clarify whether antiretroviral (ARV) prophylaxis modifies the association. Methods: From June 2005 to August 2008, HIV-infected pregnant women were counseled regarding infant feeding options, and randomly assigned to triple-ARV prophylaxis (triple ARV) until breastfeeding cessation (BFC) before age 6 months or antenatal zidovudine with single-dose nevirapine (short-course ARV). Eighteen-month HIV-free survival of infants HIV-negative at 2 weeks of age was assessed by feeding patterns (replacement feeding from birth, BFC <3 months, BFC >= 3 months). Results: Of the 753 infants alive and HIV-negative at 2 weeks, 28 acquired infection and 47 died by 18 months. Overall HIV-free survival at 18 months was 0.91 [95% confidence interval (CI): 0.88-0.93]. In the short-course ARV arm, HIV-free survival (0.88; CI: 0.84-0.91) did not differ by feeding patterns. In the triple ARV arm, overall HIV-free survival was 0.93 (CI: 0.90-0.95) and BFC <3 months was associated with lower HIV-free survival than BFC >= 3 months (adjusted hazard ratio: 0.36; CI: 0.15-0.83) and replacement feeding (adjusted hazard ratio: 0.20; CI: 0.04-0.94). In the triple ARV arm, 4 of 9 transmissions occurred after reported BFC (and 5 of 19 in the short-course arm), indicating that some women continued breastfeeding after interruption of ARV prophylaxis. Conclusions: In resource-constrained settings, early weaning has previously been associated with higher infant mortality. We show that, even with maternal triple-ARV prophylaxis during breastfeeding, early weaning remains associated with lower HIV-free survival, driven in particular by increased mortality.
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