Early mixed feeding and breastfeeding beyond 6 months increase the risk of postnatal HIV transmission: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte d'Ivoire

Becquet, Renaud; Ekouévi, Didier K.; Menan, Hervé; Amani-Bossé, Clarisse; Béquet, Laurence; Viho, Ida; Dabis, François; Timité-Konan, M.; Leroy, Valériane

doi:10.1016/j.ypmed.2007.11.014

Cited by 55 publications

(44 citation statements)

References 26 publications

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“…Our observation is consistent with those of several previous studies on the role of mixed feeding in increasing the risk of mother to child transmission of HIV infection [20]. The authors converge on the hypothesis that a mixed feeding causes damage to the intestinal wall favoring passage of virus in the blood [21].…”

Section: E N'guessan Et Al Open Journal Of Obstetrics and Gynecologysupporting

confidence: 93%

Mother-to-Child HIV Transmission Factors in Exposed Children at University Hospital Center of Treichville (Abidjan, Cote d’Ivoire)

N'guessan¹,

Dia²,

Oyelade³

et al. 2017

OJOG

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Background: The elimination of HIV transmission from mother to child is currently possible. Côte d'Ivoire, which has a 4.6% HIV prevalence among women, is one of 22 pilot countries for the elimination of mother-to-child transmission of HIV. Since 2015, Côte d'Ivoire has adopted new strategies according to the WHO B+ guidelines. Objective: To identify factors associated with mother-to-child HIV transmission in children born of seropositive mothers managed at Treichville university hospital. Material and methods: A case-control study was conducted in the obstetrics department at Treichville university hospital, between January 2013 and December 2015. It involved children born to mothers infected with HIV, whose first PCR (Polymerase Chain Reaction) result was available during this period. A standardized questionnaire on data related to exposed children and their mother was used. Factors associated with mother-to-child HIV transmission were investigated using logistic regression. Results: A total of 214 HIV-exposed children were included in the study with a sex ratio of 0.9. The majority of the children were born by vaginal route (52.8%) and received post-exposure prophylaxis (88.3%) and replacement feed (51.9%). Their mothers received antiretroviral therapy during pregnancy in 45.3% of the cases. The first PCR was performed at the sixth week of life in 52.3% of cases. The prevalence of HIV infection in exposed children was 7.5% (95% CI = 4.5% -11.8%). In multivariate analysis, the absence of antiretroviral prophylaxis in children [aOR = 4.3, 95% (1.2 to 15.6), p = 0.03], the mixed feed [aOR = 3.8, 95% (1.1 -13.1), p < 0.03], the failure to take antiretroviral regimen during pregnancy [aOR = 8.0, 95% CI (1.9 -32.4), p < 0.003], were associated with mother-child HIV transmission. Conclusion: The mother-to-child HIV transmission rate remains high in our practice. Strategies to reduce situations that do not comply with current How to cite this paper:

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Section: E N'guessan Et Al Open Journal Of Obstetrics and Gynecologysupporting

confidence: 93%

Mother-to-Child HIV Transmission Factors in Exposed Children at University Hospital Center of Treichville (Abidjan, Cote d’Ivoire)

N'guessan¹,

Dia²,

Oyelade³

et al. 2017

OJOG

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“…The present study corroborates these findings. There has been less agreement about the significance of maternal age, parity, gravidity, breast abnormalities, mode of delivery, and infant gender and birth weight [11,12]. In the present meta-analysis of the composite endpoint of HIV-1 infection or death, maternal factors of parity and breast health, and infant factors of gestational age and oral candidiasis were found to be important determinants of risk.…”

Section: Discussioncontrasting

confidence: 62%

“…These studies have identified risk associations for both maternal and infant variables [8][9][10][11][12][13][14][15][16][17]. Interpreting the combined findings from these studies has been complicated by differences in the variables considered, differences in variable definitions, and inconsistencies in the associations found.…”

Section: Introductionmentioning

confidence: 99%

Mother’s CD4+ Count Moderates the Risk Associated with Higher Parity for Late Postnatal HIV-Free Survival of Breastfed Children: An Individual Patient Data Meta-Analysis of Randomized Controlled Trials

Kovalchik

2011

AIDS Behav

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Risk association studies of late postnatal outcomes for children breastfed by HIV-1 positive mothers have had inconsistent findings and have not explored interactions among risk factors. This study addresses these limitations through an individual patient data (IPD) metaanalysis of HIV-free survival outcomes of nine randomized controlled trials to prevent early mother-to-child transmission of HIV-1. The pooled sample consisted of 3,324 African children in resource-limited settings who survived to age 28 days and were at-risk of acquiring HIV through breast milk. Based on a proportional hazards mixed effects meta-analysis, the composite endpoint of HIV-1 infection and all-cause mortality was found to be significantly associated with maternal immune status (CD4 ? C350 cells/ mm 3 , HR 0.59 95% CI (0.39, 0.87)), infant preterm delivery (gestational age \37 weeks, 1.40 (1.03, 1.89)), infant oral candidiasis infection (1.87, (1.53, 2.29)), and occurrence of breast abnormality before breastfeeding cessation (2.56 (1.90, 3.46)). A significant interaction between mother's parity (any previous pregnancy) and CD4 ? count C350 (HR 0.63 (0.40, 0.99), P-value = 0.045) suggested that higher CD4 ? count offsets the risk associated with higher parity. Further research is needed to elucidate the moderating effect of immune status on the risk associated with high parity and adverse late postnatal outcomes for infants breastfed by HIV-infected mothers in the absence of antiretroviral treatment.Keywords Gravidity Á Human Immunodeficiency Virus Á Meta-analysis Á Parity Á Prevention of maternal to child transmission of HIV Á Risk factorsResumen Estudios sobre los factores de riesgo para los hijos de madres infectadas con VIH-1 han sido inconsistentes y los investigadores no han estudiado las interacciones entre esos factores. En una respuesta a estas limitaciones, este estudio presenta un meta-análisis, basado en los datos de participantes individuales, de la supervivencia sin transmisión de VIH para niños que tienen un riesgo de adquirir el virus durante el periodo del amamantamiento. En total, la muestra incluyó 3,324 niños de naciones africanas que vivieron en circunstancias de recursos limitados, sobrevivieron a la edad de veintiocho días y que estuvieron en riesgo de adquirir VIH por la lactancia materna. Con un avanzado modelo de Cox, que tuvo effectos mezclados, se descubrió que la transmisión VIH y la mortalidad se asoció con el recuento de células CD4 ? (CD4 ? C350 células/ll, cociente de riesgo instantáneo (HR) 0.59 95% intervalo de confianza (0.39, 0.87)), el parto prematuro (la edad de gestación \37 semanas, 1.40 (1.03, 1.89)), una infección infantil de candidiasis oral (1.87, (1.53, 2.29)), y el acontecimiento de una enfermedad de los senos antes de que el periodo de lactancia se hubiera terminado (2.56 (1.90, 3.46)). Una interacción importante entre el número de partos y el recuento de células CD4 ? (HR 0.63 (0.40, 0.99), P = 0.045) sugiere que un alto recuento de células CD4 ? descuenta el riesgo asociado con el alto nú...

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“…The risk of transmission by breast milk seems to be highest with mixed feeding and breastfeeding beyond 6 months of age [40]. Whilst these findings seem to suggest that breastfeeding by an HIV-infected mother is dangerous for the non-infected infant, there is growing evidence that breastfed infants have better chances of survival and may even be protected against HIV by lactic acid bacteria in breast milk [41].…”

Section: Impact Of Infections On Nutritionmentioning

confidence: 99%

Interaction of Nutrition and Infections Globally: An Overview

Krawinkel¹

2012

Ann Nutr Metab

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The interaction of nutrition and infections is known by experience by generations of medical doctors. Before the era of antibiotics, diet was an integral part of the management of infections. Now, it is necessary to take a fresh look at this interaction as the understanding of immune response has expanded considerably. Comparatively little research has addressed the impact of nutrition interventions on the management of infectious diseases. Most observations of the interaction between nutrition and infections are epidemiological in character. This holds especially true for measles as well as for tuberculosis. In AIDS, the deterioration of the nutritional status is an indicator of disease progression. Infections in undernourished children are a common cause of death, and taking this finding into account helps to reduce the case fatality rate in severely malnourished patients. Regarding the immune response, cellular as well as soluble components are affected by deficiencies of single nutrients or general undernutrition. The immunosuppressive effect of undernutrition starts during intrauterine life already: maternal nutrition status has been shown to impact on immune function in adult animals. Recent research suggests that not only undernutrition but also caloric overnutrition impacts on immune response to infections and immunization. This is partly due to the chronic inflammatory activity of the adipose tissue and partly due to neuroendocrine alterations. Infectious diseases also impact on the nutritional status, either specifically or through unspecific mechanisms, such as anorexia, tachypnea, and vomiting.

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Early mixed feeding and breastfeeding beyond 6 months increase the risk of postnatal HIV transmission: ANRS 1201/1202 Ditrame Plus, Abidjan, Côte d'Ivoire

Cited by 55 publications

References 26 publications

Mother-to-Child HIV Transmission Factors in Exposed Children at University Hospital Center of Treichville (Abidjan, Cote d’Ivoire)

Mother-to-Child HIV Transmission Factors in Exposed Children at University Hospital Center of Treichville (Abidjan, Cote d’Ivoire)

Mother’s CD4+ Count Moderates the Risk Associated with Higher Parity for Late Postnatal HIV-Free Survival of Breastfed Children: An Individual Patient Data Meta-Analysis of Randomized Controlled Trials

Interaction of Nutrition and Infections Globally: An Overview

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