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Abstract



Morbidity and mortality among infants born to HIV-infected mothers and randomized to breastfeeding versus formula-feeding in Botswana (Mashi study)

S. Lockman1, L. Smeaton2, R. Shapiro3, I. Thior4, C. Wester4, L. Stevens4, C. Moffat4, P. Ndase4, P. Arimi4, A. Asmelash4, A. Owor4, J. Makhema4, M. Essex4, Mashi Study Team

Background: Formula feeding (FF) prevents breastfeeding-related mother-to-child HIV transmission but can cause excess infant morbidity and mortality in resource-limited settings. The safety of FF for HIV-exposed (and HIV-infected versus -uninfected) infants is not well described.


Methods: 1200 HIV-infected pregnant women were randomized to breastfeed (BF) while giving infant zidovudine prophylaxis for 6 months, or to FF with one month of infant zidovudine. We evaluated rates of infant morbidity and mortality among 1179 live-born infants by feeding arm and HIV status (ever- versus never-infected) at 6 and 24 months of age.


Results: The following table presents results at 6 months.


 ALL INFANTS

HIV-INFECTED INFANTS
HIV-NEGATIVE INFANTS
Outcome by 6 monthsBF

n=588
FF

n=591
p value BF

n=54
FF

n=33
p valueBF

n=534
FF

n=558
p value
Pneumonia (% with ³ 1 episode) 12.9% 16.2% 0.11 31.5% 48.5% 0.11 11.0% 14.3% 0.10
Grade 3/4 pneumonia (%) 4.7% 7.8% 0.03 9.4% 32.5% 0.01 4.2% 6.3% 0.13
Diarrhea (% with ³ 1 episode) 33% 35% 0.41 38% 42% 0.73 32% 34% 0.39
Grade 3/4 diarrhea (%) 0.9% 3.8% 0.001 1.8% 9.9% 0.16 0.8% 3.4% 0.003
Wasting (%)* 6.2% 4.0% 0.10 8.2% 22.7% 0.12 6.0% 3.2% 0.03
Death (%) 4.0% 8.4% 0.002 7.5% 33.3% 0.004 3.6% 6.9% 0.02
[Infant outcomes by 6 months of age]

*Weight/height z-scores £2 standard deviations below NCHS/WHO reference population.


By 24 months of age, rates of grade 3 or 4 pneumonia were higher in the FF than the BF arm (13.3% versus 8.0%, p=0.01), in both HIV-infected and -uninfected children; no other significant differences persisted.


Conclusions: FF was associated with significantly higher rates of infant mortality and severe pneumonia and diarrhea by 6 months, particularly among HIV-infected children. Twenty-four month HIV-free survival did not differ between arms. With the exception of grade 3/4 pneumonia and in the context of weaning at 6 months by the BF arm, differences by feeding arm were attenuated by 24 months.





AIDS 2006 - XVI International AIDS Conference
Abstract no. TUPE0357


Suggested Citation
"S.Lockman, et al. Morbidity and mortality among infants born to HIV-infected mothers and randomized to breastfeeding versus formula-feeding in Botswana (Mashi study). : AIDS 2006 - XVI International AIDS Conference: Abstract no. TUPE0357"