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

Bork, Kirsten; Cournil, Amandine; Read, Jennifer S.; Newell, Marie‐Louise; Cames, Cécile; Méda, Nicolas; Luchters, Stanley; Mbatia, Grace; Naidu, Kevindra; Gaillard, Philippe; Vincenzi, Isabelle De

doi:10.3945/ajcn.113.082149

Cited by 21 publications

(30 citation statements)

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“…These results contrast with the sharply increased risk of severe morbidity and mortality among neverbreastfed children in this and other studies (6,7,(32)(33)(34)(35). Reverse causality is not likely to explain differences related to LAZ, but residual confounding cannot be ruled out.…”

Section: Discussioncontrasting

confidence: 55%

“…However, we did not expect such a pattern in lowincome sub-Saharan populations of HIV-infected mothers. Indeed, we previously reported 6-fold increased risk of serious infectious morbidity and mortality among never-breastfed infants compared with those exclusively breastfed $3 mo in the Kesho Bora study (6,7). We expected that such high excess risk of severe morbidity among never-breastfed infants would be reflected in less-favorable linear growth patterns, but this was not the case.…”

Section: Discussionmentioning

confidence: 71%

“…Stunting also has been associated with school failure and impaired adult socioeconomic status and reproductive health (1,2). Lack of breastfeeding is associated with increased risks of infectious morbidity and mortality in infancy and in some studies with lower cognitive development and adult income (3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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Formula-Feeding of HIV-Exposed Uninfected African Children Is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study

Bork

Cames

Newell

et al. 2017

The Journal of Nutrition

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 71%

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Formula-Feeding of HIV-Exposed Uninfected African Children Is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study

Bork

Cames

Newell

et al. 2017

The Journal of Nutrition

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“…While our study noted impact of any breastfeeding, other studies have also noted strong protective effects of exclusive breastfeeding 23,24 . Rates of exclusive breastfeeding were low in our cohort and duration was short, limiting our ability to compare exclusively breastfed infants and mixed-fed infants.…”

Section: Discussioncontrasting

confidence: 45%

Breastfeeding Is Associated with Decreased Risk of Hospitalization among HIV-Exposed, Uninfected Kenyan Infants

et al. 2015

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Background HIV-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa, with higher morbidity and mortality than HIV-unexposed infants. HEU infants may experience increased morbidity due to breastfeeding avoidance. Objective We sought to describe the burden and identify predictors of hospitalization among HEU infants in the first year of life. Methods Using a retrospective cohort of HIV-infected mothers and their HEU infants in Nairobi, Kenya, we identified infants who were HIV-uninfected at birth and were followed monthly until last negative HIV test, death, loss to follow-up or study exit at one year of age. Incidence, timing and reason for hospitalization was assessed overall as well as stratified by feeding method. Predictors of first infectious disease hospitalization were identified using competing risk regression, with HIV acquisition and death as competing risks. Results Among 388 infants, 113 hospitalizations were reported [35/100 infant-years, 95% confidence interval (CI) 29–42]. Ninety hospitalizations were due to one or more infectious diseases [26/100 infant-years, 95%CI 21–32], primarily pneumonia (n=40), gastroenteritis (n=17) and sepsis (n=14). Breastfeeding was associated with decreased risk of infectious disease hospitalization [SHR=0.39 (95%CI 0.24–0.64)], as was time-updated nutritional status [SHR=0.73 (95%CI 0.61–0.89)]. Incidence of infectious disease hospitalization among formula-fed infants was 51/100 child-years (95%CI 37–70) compared to 19/100 child-years (95%CI 14–25) among breastfed infants. Conclusion Among HEU infants, breastfeeding and nutritional status were associated with reduced hospitalization during the first year of life.

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“…Thirteen of the 14 studies included in the meta-analysis were undertaken in sub-Saharan Africa, and one was conducted in India. All included studies were observational in nature: eight were nested within clinical trials [26][27][28][29][30][31][32][33] and six were based on cohort data [4][5][6][34][35][36]. The majority were undertaken before the widespread use of maternal ART.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Mortality risk and associated factors in HIV‐exposed, uninfected children

Arikawa

Rollins

Newell

et al. 2016

Tropical Med Int Health

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ObjectiveWith increasing maternal antiretroviral treatment (ART), the number of children newly infected with HIV has declined. However, the possible increased mortality in the large number of HIV‐exposed, uninfected (HEU) children may be of concern. We quantified mortality risks among HEU children and reviewed associated factors.MethodsSystematic search of electronic databases (PubMed, Scopus). We included all studies reporting mortality of HEU children to age 60 months and associated factors. Relative risk of mortality between HEU and HIV‐unexposed, uninfected (HUU) children was extracted where relevant. Inverse variance methods were used to adjust for study size. Random‐effects models were fitted to obtain pooled estimates.ResultsA total of 14 studies were included in the meta‐analysis and 13 in the review of associated factors. The pooled cumulative mortality in HEU children was 5.5% (95% CI: 4.0–7.2; I 2 = 94%) at 12 months (11 studies) and 11.0% (95% CI: 7.6–15.0; I 2 = 93%) at 24 months (four studies). The pooled risk ratios for the mortality in HEU children compared to HUU children in the same setting were 1.9 (95% CI: 0.9–3.8; I 2 = 93%) at 12 months (four studies) and 2.4 (95% CI: 1.1–5.1; I 2 = 93%) at 24 months (three studies).ConclusionCompared to HUU children, mortality risk in HEU children was about double at both age points, although the association was not statistically significant at 12 months. Interpretation of the pooled estimates is confounded by considerable heterogeneity between studies. Further research is needed to characterise the impact of maternal death and breastfeeding on the survival of HEU infants in the context of maternal ART, where current evidence is limited.

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

Abstract: Not breastfeeding was associated with increased risk of serious infections especially between 0 and 2.9 mo of age. The randomized controlled trial component of the Kesho Bora study was registered at Current Controlled Trials (www.controlled-trials.com) as ISRCTN71468401.

Cited by 21 publications

References 32 publications

Formula-Feeding of HIV-Exposed Uninfected African Children Is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study

Formula-Feeding of HIV-Exposed Uninfected African Children Is Associated with Faster Growth in Length during the First 6 Months of Life in the Kesho Bora Study

Breastfeeding Is Associated with Decreased Risk of Hospitalization among HIV-Exposed, Uninfected Kenyan Infants

Mortality risk and associated factors in HIV‐exposed, uninfected children

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