Growth patterns and clinical outcomes in association with breastfeeding duration in HIV exposed and unexposed infants: a cohort study in KwaZulu Natal, South Africa

Pillay, Larisha; Moodley, Dhayendre; Emel, Lynda; Nkwanyana, None Ntombifikile M.; Naidoo, Kimesh

doi:10.1186/s12887-021-02662-8

Cited by 13 publications

(11 citation statements)

References 23 publications

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“…In our study, a lower mean LAZ was found in HEU infants at 6 months, which is similar to another South African study [ 58 ], and a lower mean HCZ was also reported in Zimbabwe at 6 months [ 59 ]. A lower mean LAZ was also observed at 9 months in HEU infants as compared to HUU infants, similar to other studies in Uganda [ 60 ], Rwanda [ 61 ], and Botswana [ 10 ].…”

Section: Discussionsupporting

confidence: 91%

Comparison of Feeding Practices and Growth of Urbanized African Infants Aged 6–12 Months Old by Maternal HIV Status in Gauteng Province, South Africa

et al. 2023

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Appropriate feeding practices are protective against malnutrition and poor growth. We compared feeding practices and growth in HIV-exposed-uninfected (HEU) and HIV-unexposed-uninfected (HUU) between 6-12 months of age in urbanized African infants in South Africa. A repeated cross-sectional analysis was used to determine differences in infant feeding practices and anthropometric measures by HIV exposure status at 6, 9, and 12 months in the Siyakhula study. The study included 181 infants (86 HEU; 95 HUU). Breastfeeding rates were lower in HEU vs. HUU infants at 9 (35.6% vs. 57.3%; p = 0.013) and 12 months (24.7% vs. 48.0%; p = 0.005). Introduction to early complementary foods was common (HEU = 16.2 ± 11.0 vs. HUU = 12.8 ± 9.3 weeks; p = 0.118). Lower weight-for-age Z-scores (WAZ) and head circumference-for-age Z-scores (HCZ) were found in HEU infants at birth. At 6 months, WAZ, length-for-age Z-scores (LAZ), HCZ, and mid-upper-arm circumference-for-age Z-scores (MUACAZ) were lower in HEU vs. HUU infants. At 9 months, lower WAZ, LAZ, and MUACAZ were found in HEU vs. HUU infants. At 12 months, lower WAZ, MUACAZ, and weight-for-length Z-scores (−0.2 ± 1.2 vs. 0.2 ± 1.2; p = 0.020) were observed. HEU infants had lower rates of breastfeeding and poorer growth compared to HUU infants. Maternal HIV exposure affects the feeding practices and growth of infants.

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Section: Discussionsupporting

confidence: 91%

Comparison of Feeding Practices and Growth of Urbanized African Infants Aged 6–12 Months Old by Maternal HIV Status in Gauteng Province, South Africa

et al. 2023

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“…While the causes of this increased morbidity in infants who are HEU are multifactorial, in-utero exposure to ARVs may be a contributing factor. Recent studies have shown reassuring results that breastfeeding while on ART is the optimal feeding strategy for HIV-exposed infants in most resource-limited settings [ 5 , 12 , 13 ]. However, it is cause for concern that the comparative growth of infants who are HEU and HU has highlighted early onset of obesity in late infancy [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…While not all studies show the same early adverse outcomes of in-utero exposures, some have found alterations in growth [ 8 , 9 , 16 – 20 ]. In particular, infants who are HEU may experience a higher risk of suboptimal growth in infancy [ 4 , 5 , 8 , 13 , 16 – 18 , 20 – 22 ] with these effects persisting through to school-going age [ 7 , 23 ]. Many studies however, (1) lack comparison with children who are HU.…”

Section: Introductionmentioning

confidence: 99%

Growth patterns of infants with in- utero HIV and ARV exposure in Cape Town, South Africa and Lusaka, Zambia

et al. 2022

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Background Infants born HIV-exposed yet remain uninfected (HEU) are at increased risk of poorer growth and health compared to infants born HIV-unexposed (HU). Whether maternal antiretroviral treatment (ART) in pregnancy ameliorates this risk of poorer growth is not well understood. Furthermore, whether risks are similar across high burden HIV settings has not been extensively explored. Methods We harmonized data from two prospective observational studies conducted in Cape Town, South Africa, and Lusaka, Zambia, to compare weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) Z-scores between infants who were HEU and HU, converting infant anthropometric measures using World Health Organisation Growth Standards adjusted for age and sex. Linear mixed effects models were fit to identify risk factors for differences in anthropometrics at 6–10 weeks and 6 months by infant HIV exposures status and by timing of exposure to maternal ART, either from conception or later in gestation. Results Overall 773 mother-infant pairs were included across two countries: women living with HIV (WLHIV), 51% (n = 395) with 65% on ART at conception and 35% initiating treatment in pregnancy. In linear mixed effects models, WAZ and WLZ at 6–10 weeks were lower among infants who were HEU vs HU [β = − 0.29 (95% CI: − 0.46, − 0.12) and [β = − 0.42 (95% CI: − 0.68, − 0.16)] respectively after adjusting for maternal characteristics and infant feeding with a random intercept for country. At 6 months, LAZ was lower [β = − 0.28 CI: − 0.50, − 0.06)] among infants who were HEU, adjusting for the same variables, with no differences in WAZ and WLZ. Within cohort evaluations identified different results with higher LAZ among infants who were HEU from Zambia at 6–10 weeks, [β = + 0.34 CI: + 0.01, + 0.68)] and lower LAZ among infants who were HEU from South Africa [β = − 0.30 CI: − 0.59, − 0.01)] at 6 months, without other anthropometric differences at either site. Conclusion Infant growth trajectories differed by country, highlighting the importance of studying contextual influences on outcomes of infants who were HEU.

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“…We were concerned that pooling this way risked misidentifying breastfeeding differences between countries in Southern Africa as a change over time because of the smaller number of surveys in the region and the relatively short breastfeeding duration in South Africa. 50 We were reassured that a sensitivity analysis excluding the 2016 DHS of South Africa did not change regional estimates of breastfeeding patterns substantially.…”

Section: Discussionmentioning

confidence: 93%

Differences in Breastfeeding Duration by Maternal HIV Status: A Pooled Analysis of Nationally Representative Surveys in Sub-Saharan Africa

Glaubius,

Stover,

Johnson

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Breastfeeding improves child survival but is a source of mother-to-child HIV transmission among women with unsuppressed HIV infection. Estimated HIV incidence in children is sensitive to breastfeeding duration among mothers living with HIV (MLHIV). Breastfeeding duration may vary according to maternal HIV status. Setting: Sub-Saharan Africa. Methods: We analyzed pooled data from nationally representative household surveys conducted during 2003–2019 that included HIV testing and elicited breastfeeding practices. We fitted survival models of breastfeeding duration by country, year, and maternal HIV status for 4 sub-Saharan African regions (Eastern, Central, Southern, and Western). Results: Data were obtained from 65 surveys in 31 countries. In 2010, breastfeeding in the first month of life (“initial breastfeeding”) among MLHIV ranged from 69.1% (95% credible interval: 68–79.9) in Southern Africa to 93.4% (92.7–98.0) in Western Africa. Median breastfeeding duration among MLHIV was the shortest in Southern Africa at 15.6 (14.2–16.3) months and the longest in Eastern Africa at 22.0 (21.7–22.5) months. By comparison, HIV-negative mothers were more likely to breastfeed initially (91.0%–98.7% across regions) and for longer duration (median 18.3–24.6 months across regions). Initial breastfeeding and median breastfeeding duration decreased during 2005–2015 in most regions and did not increase in any region regardless of maternal HIV status. Conclusions: MLHIV in sub-Saharan Africa are less likely to breastfeed initially and stop breastfeeding sooner than HIV-negative mothers. Since 2020, UNAIDS-supported HIV estimates have accounted for this shorter breastfeeding exposure among HIV-exposed children. MLHIV need support to enable optimal breastfeeding practices and to adhere to antiretroviral therapy for HIV treatment and prevention of postnatal mother-to-child transmission.

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Growth patterns and clinical outcomes in association with breastfeeding duration in HIV exposed and unexposed infants: a cohort study in KwaZulu Natal, South Africa

Cited by 13 publications

References 23 publications

Comparison of Feeding Practices and Growth of Urbanized African Infants Aged 6–12 Months Old by Maternal HIV Status in Gauteng Province, South Africa

Comparison of Feeding Practices and Growth of Urbanized African Infants Aged 6–12 Months Old by Maternal HIV Status in Gauteng Province, South Africa

Growth patterns of infants with in- utero HIV and ARV exposure in Cape Town, South Africa and Lusaka, Zambia

Differences in Breastfeeding Duration by Maternal HIV Status: A Pooled Analysis of Nationally Representative Surveys in Sub-Saharan Africa

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