Early infant feeding patterns and HIV-free survival: findings from the Kesho-Bora trial (Burkina Faso, Kenya, South Africa).



Objective: To investigate the association between feeding patterns and HIV-free survival in children born to HIV-infected mothers and to clarify whether antiretroviral (ARV) prophylaxis modifies the association.

Methods: From June 2005 to August 2008, HIV-infected pregnant women were counseled regarding infant feeding options, and randomly assigned to triple-ARV prophylaxis (triple ARV) until breastfeeding cessation (BFC) before age 6 months or antenatal zidovudine with single-dose nevirapine (short-course ARV). Eighteen-month HIV-free survival of infants HIV-negative at 2 weeks of age was assessed by feeding patterns (replacement feeding from birth, BFC <3 months, BFC >= 3 months).

Results: Of the 753 infants alive and HIV-negative at 2 weeks, 28 acquired infection and 47 died by 18 months. Overall HIV-free survival at 18 months was 0.91 [95% confidence interval (CI): 0.88-0.93]. In the short-course ARV arm, HIV-free survival (0.88; CI: 0.84-0.91) did not differ by feeding patterns. In the triple ARV arm, overall HIV-free survival was 0.93 (CI: 0.90-0.95) and BFC <3 months was associated with lower HIV-free survival than BFC >= 3 months (adjusted hazard ratio: 0.36; CI: 0.15-0.83) and replacement feeding (adjusted hazard ratio: 0.20; CI: 0.04-0.94). In the triple ARV arm, 4 of 9 transmissions occurred after reported BFC (and 5 of 19 in the short-course arm), indicating that some women continued breastfeeding after interruption of ARV prophylaxis.

Conclusions: In resource-constrained settings, early weaning has previously been associated with higher infant mortality. We show that, even with maternal triple-ARV prophylaxis during breastfeeding, early weaning remains associated with lower HIV-free survival, driven in particular by increased mortality.

Author Keywords:infant; HIV-free survival; prevention of mother-to-child transmission; breastfeeding; antiretroviral therapy; Africa

Authors & affiliation: 
Cournil, Amandine PhD*; Van de Perre, Philippe PhD†; Cames, Cécile PhD*; de Vincenzi, Isabelle PhD‡; Read, Jennifer S. MD§; Luchters, Stanley MD¶||; Meda, Nicolas PhD**; Naidu, Kevi MD††; Newell, Marie-Louise PhD‡‡; Bork, Kirsten PhD*; for the Kesho Bora Study Group *UMI 233, Institut de Recherche pour le Développement, Université Montpellier 1, Montpellier, France; †Department of Bacteriology-Virology, Institut National de la Santé et de la Recherche Médicale (INSERM) U1058; Université Montpellier and CHRU Montpellier, Montpellier, France; ‡Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; §National Institutes of Health, Bethesda, Maryland; ¶International Centre for Reproductive Health (ICRH), Mombasa, Kenya; ||International Centre for Reproductive Health, Ghent University, Ghent, Belgium; **Centre Muraz, Bobo-Dioulasso, Burkina Faso; ††University of KwaZulu-Natal, Durban, South Africa; ‡‡Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa; and §§The Kesho Bora Study Group m
Published In: 
Pediatr Infect Dis J. 2015 Feb;34(2):168-74. doi: 10.1097/INF.0000000000000512
Publication date: 
Monday, February 2, 2015