Breastfeeding is associated with decreased pneumonia incidence among HIV-exposed, uninfected Kenyan infants

Abstract

Objective HIV-exposed uninfected infants (HEU) have higher infectious disease morbidity and mortality than unexposed infants. We determined the incidence and risk factors for pneumonia, a leading cause of infant mortality worldwide, in a cohort of HEU infants. Identifying predictors of pneumonia among HEU infants may enable early identification of those at highest risk. Design A retrospective cohort of HEU participating in a Kenyan perinatal HIV study, enrolled between 1999-2002. Methods Infants were followed monthly from birth to 12 months. Incidence of pneumonia diagnosed at monthly study visits, sick-child visits or by means of a verbal autopsy, was estimated with a 14-day window for new episodes. Cox proportional hazards regression was used to identify predictors of first pneumonia occurrence. Results Among 388 HEU infants with 328 person-years of follow-up, the incidence of pneumonia was 900/1,000 child-years (95% CI: 800-1,000). Maternal HIV viral load at 32 weeks gestation [HR=1.2 (1.0-1.5) per log10 difference] and being underweight (weight-for-age Z-score <-2) at the previous visit [HR=1.8 (1.1-2.8)] were associated with increased risk of pneumonia. Breastfed infants had a 47% lower risk of pneumonia than those never breastfed [HR=0.53 (0.39-0.73)], independent of infant growth, maternal viral load and maternal CD4%. Breastfeeding was also associated with a 74% lower risk of pneumonia-related hospitalization (HR=0.26 (0.13-0.53)). Conclusions The incidence of pneumonia in this cohort of HEU infants was high. Our observations suggest that maternal viral suppression and breastfeeding may reduce the burden of pneumonia among HEU.

Tuberculosis Infection in Early Childhood and the Association with HIV-exposure in HIV-uninfected Children in Rural Uganda

“…Due to the cross-sectional nature of this study we were not able to account for survivorship bias and age-cohort effects that could have affected age-specific trends in TB infection. Advanced maternal immunosuppression has been associated with a higher risk of morbidity and mortality among HEU, 47,12,29 thus it is possible that our study underestimates the risk of TB infection among HEU children given 70% of women in our study are on ART. Lastly, generalizability may be limited as the sample was recruited from women and children participating in a clinical trial on malaria and HIV.…”

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

“…However, both of these analyses included both HIV-uninfected and -infected infants, and the latter infants are known to be very vulnerable to the absence of breastfeeding. In Kenyan uninfected HIV-exposed infants, the protection provided by breastfeeding was also greater for all pneumonia cases than pneumonia-related hospitalization (29).…”

High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women

“…3,4 Compared with formula feeding, EBF has been associated with decreased risk of respiratory and gastrointestinal infections, and lower infant mortality. 2,[4][5][6][7][8][9] While this survival benefit is most pronounced in the developing world where risk from contaminated water is high, it has also been observed in high-income settings. 5,9 Although breastmilk can be a vehicle for mother-to-child HIV transmission (MTCT), EBF is the preferred infant feeding option for HIV-infected mothers in developing countries.…”