Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study.

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dc.contributor.authorCoutsoudis, A.
dc.contributor.authorPillay, K.
dc.contributor.authorSpooner, E.
dc.contributor.authorKuhn, L.
dc.contributor.authorCoovadia, H.M.
dc.contributor.departmentDepartment of Paediatrics and Child Health, University of Natal, South Africa.en_US
dc.date.accessioned2020-06-26T13:03:39Z
dc.date.available2020-06-26T13:03:39Z
dc.date.epub1999
dc.date.issued1999-08-07
dc.description.abstractBackground: The observation that mother-to-child transmission of HIV-1 can occur through breastfeeding has resulted in policies that recommend avoidance of breastfeeding by HIV-1-infected women in the developed world and under specific circumstances in developing countries. We compared transmission rates in exclusively breastfed, mixed-fed, and formula-fed (never breastfed) infants to assess whether the pattern of breastfeeding is a critical determinant of early mother-to-child transmission of HIV-1. Methods: We prospectively assessed infant-feeding practices of 549 HIV-1-infected women who were part of a vitamin A intervention trial in Durban, South Africa. The proportions of HIV-1-infected infants at 3 months (estimated by use of Kaplan-Meier life tables) were compared in the three different feeding groups. HIV-1 infection was defined by a positive RNA-PCR test. Findings: At 3 months, 18.8% (95% CI 12.6-24.9) of 156 never-breastfed children were estimated to be HIV-1 infected compared with 21.3% (17.2-25.5) of 393 breastfed children (p=0.5). The estimated proportion (Kaplan-Meier) of infants HIV-1 infected by 3 months was significantly lower for those exclusively breastfed to 3 months than in those who received mixed feeding before 3 months (14.6% [7.7-21.4] vs 24.1% [19.0-29.2], p=0.03). After adjustment for potential confounders (maternal CD4-cell/CD8-cell ratio, syphilis screening test results, and preterm delivery), exclusive breastfeeding carried a significantly lower risk of HIV-1 transmission than mixed feeding (hazard ratio 0.52 [0.28-0.98]) and a similar risk to no breastfeeding (0.85 [0.51-1.42]). Interpretations: Our findings have important implications for prevention of HIV-1 infection and infant-feeding policies in developing countries and further research is essential. In the meantime, breastfeeding policies for HIV-1-infected women require urgent review. If our findings are confirmed, exclusive breastfeeding may offer HIV-1-infected women in developing countries an affordable, culturally acceptable, and effective means of reducing mother-to-child transmission of HIV-1 while maintaining the overwhelming benefits of breastfeeding..en_US
dc.description.sponsorshipWe thank H Holst, superintendent of McCord Hospital for valuable cooperation and allowing us access to patients in the antenatal clinic; L Dwarkapersad, chief medical superintendent of King Edward Hospital for permission to conduct the study; the nursing staff at McCord and King Edward Hospitals for their assistance and cooperation; T Ngubane, T Buthelezi, and J Sibanyoni for providing counselling to the women in the study; D Naicker, A Mngadi, and J Mshenshela for assistance with the follow-up clinics; I Elson (Department of Chemical Pathology, University of Natal), for vitamin A analysis; A Smith, D York, S Madurai (Department of Virology, University of Natal) for HIV antibody testing; Z Stein (Gertrude H Sergievsky Center, Columbia University, New York) for valuable discussions about study design and interpretation of data; and the mothers and their children for participating in the study. The study was partly funded by grants from the AIDS Directorate, National Department of Health, South Africa; South African Medical Research Council; University of Natal Research Fund and Opportunities for Micronutrient Initiatives/USAID. Vitamin A and placebo were supplied by Roche, South Africa, and capsules were packaged by Hersol Laboratories, South Africaen_US
dc.identifier.citationCoutsoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM. Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. South African Vitamin A Study Group. Lancet (London, England)en_US
dc.identifier.journalElsevieren_US
dc.identifier.urihttps://infospace.mrc.ac.za/handle/11288/595249
dc.language.isoenen_US
dc.publisherThe Lanceten_US
dc.relation.url10.1016/s0140-6736(99)01101-0en_US
dc.research.unitClosed Unitsen_US
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.subjectFeedingen_US
dc.subjectHIVen_US
dc.subjectTransmisionen_US
dc.subjectInfanten_US
dc.subjectSouth Africaen_US
dc.titleInfluence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study.en_US
dc.typeArticleen_US
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