Survival of infants born to HIV-positive mothers, by feeding modality, in Rakai, Uganda

Joseph Kagaayi, Ronald H. Gray, Heena Brahmbhatt, Godfrey Kigozi, Fred Nalugoda, Fred Wabwire-Mangen, David Serwadda, Nelson Sewankambo, Veronica Ddungu, Darix Ssebagala, Joseph Sekasanvu, Grace Kigozi, Fredrick Makumbi, Noah Kiwanuka, Tom Lutalo, Steven J. Reynolds, Maria J. Wawer

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Data comparing survival of formula-fed to breast-fed infants in programmatic settings are limited. We compared mortality and HIV-free of breast and formula-fed infants born to HIV-positive mothers in a program in rural, Rakai District Uganda. Methodology/Principal Findings: One hundred eighty two infants born to HIV-positive mothers were followed at one, six and twelve months postpartum. Mothers were given infant-feeding counseling and allowed to make informed choices as to whether to formula-feed or breast-feed. Eligible mothers and infants received antiretroviral therapy (ART) if indicated. Mothers and their newborns received prophylaxis for prevention of mother-to-child HIV transmission (pMTCT) if they were not receiving ART. Infant HIV infection was detected by PCR (Roche Amplicor 1.5) during the follow-up visits. Kaplan Meier time-to-event methods were used to compare mortality and HIV-free survival. The adjusted hazard ratio (Adjusted HR) of infant HIV-free survival was estimated by Cox regression. Seventy-five infants (41%) were formula-fed while 107 (59%) were breast-fed. Exclusive breast-feeding was practiced by only 25% of breast-feeding women at one month postpartum. The cumulative 12-month probability of infant mortality was 18% (95% CI = 11%-29%) among the formula-fed compared to 3% (95% CI = 1%-9%) among the breast-fed infants (unadjusted hazard ratio (HR) = 6.1(95% CI = 1.7-21.4, P-value < 0.01). There were no statistically significant differentials in HIV-free survival by feeding choice (86% in the formula-fed compared to 96% in breast-fed group (Adjusted RH = 2.8 [95%CI = 0.67-11.7, P-value = 0.16] Conclusions/Significance: Formula-feeding was associated with a higher risk of infant mortality than breastfeeding in this rural population. Our findings suggest that formula-feeding should be discouraged in similar African settings.

Original languageEnglish (US)
Article numbere3877
JournalPloS one
Volume3
Issue number12
DOIs
StatePublished - Dec 9 2008

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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