Frequency of gastroenteritis and gastroenteritis-associated mortality with early weaning in HIV-1-uninfected children born to HIV-infected women in malawi

George Kafulafula, Donald R. Hoover, Taha E. Taha, Michael Thigpen, Qing Li, Mary Glenn Fowler, Newton I. Kumwenda, Kondwani Nkanaunena, Linda Mipando, Lynne M. Mofenson

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: We assessed gastroenteritis (GE) burden in 2 randomized trials conducted in Malawi to reduce postnatal HIV transmission before and after World Health Organization recommendations regarding exclusive breastfeeding for HIV-exposed infants were adopted. The 2 trials were the nevirapine/AZT (NVAZ, 2000-2003 with prolonged breastfeeding) and the Postexposure Prophylaxis to the Infant (PEPI, 2004-2007 with breastfeeding cessation by 6 months). METHODS: From NVAZ and PEPI trials data, GE frequency through age 12 months among HIV-negative exposed infants was evaluated. Overall and GE-related cumulative mortality rates were estimated using Kaplan-Meier curves. RESULTS: The frequency of at least one GE-related hospitalization was greater in PEPI vs. NVAZ after age 6 months (respectively, 2.9% vs. 0.1%, at 7-9 months and 1.6% vs. 0.2% at 10-12 months, P < 0.001). Cumulative GE-related mortality was significantly higher in PEPI than in NVAZ after age 6 months; at ages 9 and 12 months GE-related mortality was 19 and 24 per 1000 infants in PEPI vs. 7 and 12 per 1000 infants in NVAZ (P = 0.0002). CONCLUSIONS: Early weaning was associated with increased risk of severe GE and GE-related mortality among HIV-exposed infants. Strategies are urgently needed which allow longer breastfeeding while reducing the risk of HIV breast milk transmission in resource-limited settings.

Original languageEnglish (US)
Pages (from-to)6-13
Number of pages8
JournalJournal of acquired immune deficiency syndromes
Volume53
Issue number1
DOIs
StatePublished - Jan 2010

Keywords

  • Breastfeeding
  • Gastroenteritis
  • HIV-exposed infant
  • Mortality
  • Weaning

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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