Breastfeeding Among Women Living With HIV in the Era of Lifelong ART: An Observational Multicountry Study in Eastern and Southern Africa.
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 Jan 2024
01 Jan 2024
Historique:
received:
17
03
2023
accepted:
30
08
2023
medline:
7
12
2023
pubmed:
21
9
2023
entrez:
21
9
2023
Statut:
ppublish
Résumé
Lifelong antiretroviral treatment (ART) use is recommended for pregnant and breastfeeding (BF) women living with HIV (WLWH) to prevent perinatal HIV transmission and improve maternal health. We address 2 objectives in this analysis: (1) determine timing and factors associated with BF cessation and (2) assess the impact of BF on health of WLWH on ART. This multicountry study included 8 sites in Uganda, Malawi, Zimbabwe, and South Africa. This was a prospective study of WLWH on lifelong ART. These women initially participated from 2011 to 2016 in a randomized clinical trial (PROMISE) to prevent perinatal HIV transmission and subsequently reenrolled in an observational study (PROMOTE, 2016-2021) to assess ART adherence, safety, and impact. The PROMOTE cohort included 1987 women on ART. Of them, 752 breastfed and were included in analyses of objective 1; all women were included in analyses of objective 2. The median time to BF cessation varied by country (11.2-19.7 months). Country of residence, age, and health status of women were significantly associated with time to BF cessation (compared with Zimbabwe: Malawi, adjusted hazard ratio [aHR] 0.50, 95% confidence interval [95% CI]: 0.40 to 0.62, P < 0.001; South Africa, aHR 1.49, 95% CI: 1.11 to 2.00, P = 0.008; and Uganda, aHR 1.77, 95% CI: 1.37 to 2.29, P < 0.001). Women who breastfed had lower risk of being "unwell" compared with women who never breastfed (adjusted rate ratio 0.87, 95% CI: 0.81 to 0.95 P = 0.030). Women on lifelong ART should be encouraged to continue BF with no concern for their health. Time to BF cessation should be monitored for proper counseling in each country.
Sections du résumé
BACKGROUND
BACKGROUND
Lifelong antiretroviral treatment (ART) use is recommended for pregnant and breastfeeding (BF) women living with HIV (WLWH) to prevent perinatal HIV transmission and improve maternal health. We address 2 objectives in this analysis: (1) determine timing and factors associated with BF cessation and (2) assess the impact of BF on health of WLWH on ART.
SETTING
METHODS
This multicountry study included 8 sites in Uganda, Malawi, Zimbabwe, and South Africa.
METHODS
METHODS
This was a prospective study of WLWH on lifelong ART. These women initially participated from 2011 to 2016 in a randomized clinical trial (PROMISE) to prevent perinatal HIV transmission and subsequently reenrolled in an observational study (PROMOTE, 2016-2021) to assess ART adherence, safety, and impact.
RESULTS
RESULTS
The PROMOTE cohort included 1987 women on ART. Of them, 752 breastfed and were included in analyses of objective 1; all women were included in analyses of objective 2. The median time to BF cessation varied by country (11.2-19.7 months). Country of residence, age, and health status of women were significantly associated with time to BF cessation (compared with Zimbabwe: Malawi, adjusted hazard ratio [aHR] 0.50, 95% confidence interval [95% CI]: 0.40 to 0.62, P < 0.001; South Africa, aHR 1.49, 95% CI: 1.11 to 2.00, P = 0.008; and Uganda, aHR 1.77, 95% CI: 1.37 to 2.29, P < 0.001). Women who breastfed had lower risk of being "unwell" compared with women who never breastfed (adjusted rate ratio 0.87, 95% CI: 0.81 to 0.95 P = 0.030).
CONCLUSION
CONCLUSIONS
Women on lifelong ART should be encouraged to continue BF with no concern for their health. Time to BF cessation should be monitored for proper counseling in each country.
Identifiants
pubmed: 37732877
doi: 10.1097/QAI.0000000000003306
pii: 00126334-990000000-00296
doi:
Substances chimiques
Anti-Retroviral Agents
0
Types de publication
Randomized Controlled Trial
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
10-17Subventions
Organisme : NIAID NIH HHS
ID : UM1 AI069518
Pays : United States
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no funding or conflicts of interest to disclose.
Références
World Health Organization, United Nation Children’s Fund. Updates on HIV and Infant Feeding: The Duration of Breastfeeding, and Support from Health Services to Improve Feeding Practices Among Mothers Living with HIV. Geneva, Switzerland: World Health Organization; 2016.
United Nations Inter-agency Group for Child Mortality Estimation. Levels & Trends in Child Mortality: Report 2021. Estimates Developed by the United Nations Inter-Agency Group for Child Mortality Estimation. New York, NY: UNICEF; 2021.
Fowler MG, Qin M, Fiscus SA, et al. Benefits and risks of antiretroviral therapy for perinatal HIV prevention. N Engl J Med. 2016;375:1726–1737.
Flynn PM, Taha TE, Cababasay M, et al. Prevention of HIV-1 transmission through breastfeeding: efficacy and safety of maternal antiretroviral therapy versus infant nevirapine prophylaxis for duration of breastfeeding in HIV-1-infected women with high CD4 cell count (IMPAACT PROMISE): a randomized, open label, clinical trial. J Acquir Immune Defic Syndr. 2018;77:383–392.
Taha TE, Yende-Zuma N, Brummel SS, et al. Effects of long-term antiretroviral therapy in reproductive-age women in sub-Saharan Africa (the PEPFAR PROMOTE study): a multi-country observational cohort study. Lancet HIV. 2022;9:e394–e403.
Nduati R, Richardson BA, John G, et al. Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial. Lancet. 2001;357:1651–1655.
Otieno PA, Brown ER, Mbori-Ngacha DA, et al. HIV-1 disease progression in breast-feeding and formula-feeding mothers: a prospective 2-year comparison of T cell subsets, HIV-1 RNA levels, and mortality. J Infect Dis. 2007;195:220–229.
Kuhn L, Kasonde P, Sinkala M, et al. Prolonged breast-feeding and mortality up to two years post-partum among HIV-positive women in Zambia. AIDS. 2005;19:1677–1681.
Sedgh G, Spiegelman D, Larsen U, et al. Breastfeeding and maternal HIV-1 disease progression and mortality. AIDS. 2004;18:1043–1049.
Taha TE, Kumwenda NI, Hoover DR, et al. The impact of breastfeeding on the health of HIV-positive mothers and their children in sub-Saharan Africa. Bull World Health Organ. 2006;84:546–554.
Cames C, Cournil A, de Vincenzi I, et al. Postpartum weight change among HIV-infected mothers by antiretroviral prophylaxis and infant feeding modality in a research setting. AIDS. 2014;28:85–94.
Papathakis PC, Loan MDV, Rollins NC, et al. Body composition changes during lactation in HIV-infected and HIV-uninfected South African women. J Acquir Immune Defic Syndr. 2006;43:467–474.
Guay LA, Musoke P, Fleming T, et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet. 1999;354:795–802.
Taha TE, Kumwenda NI, Gibbons A, et al. Short postexposure prophylaxis in newborn babies to reduce mother-to-child transmission of HIV-1: NVAZ randomised clinical trial. Lancet. 2003;362:1171–1177.
Kumwenda NI, Hoover DR, Mofenson LM, et al. Extended antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med. 2008;359:119–129.
Thior I, Lockman S, Smeaton LM, et al. Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study. JAMA. 2006;296:794–805.
Somé EN, Engebretsen IMS, Nagot N, et al. HIV-1 disease progression in immune-competent HIV-1-infected and breastfeeding mothers participating in the ANRS 12174 clinical trial in Burkina Faso, South Africa, Uganda and Zambia: a cohort study. BMJ Open. 2018;8:e019239.
Venter WDF, Moorhouse M, Sokhela S, et al. Dolutegravir plus two different prodrugs of tenofovir to treat HIV. N Engl J Med. 2019;381:803–815.
Amir LH, Donath S. A systematic review of maternal obesity and breastfeeding intention, initiation and duration. BMC Pregnancy Childbirth. 2007;7:9.
Zubaran C, Foresti K. Correlation between breastfeeding and maternal health status. Einstein. 2013;11:180–185.
Jakobsen MS, Sodemann M, Mølbak K, et al. Reason for termination of breastfeeding and the length of breastfeeding. Int J Epidemiol. 1996;25:115–121.
Taha TE, Yende-Zuma N, Aizire J, et al. The multi-country PROMOTE HIV antiretroviral treatment observational cohort in Sub-Saharan Africa: objectives, design, and baseline findings. PLoS One. 2018;13:e0208805.
Goon DT, Ajayi AI, Adeniyi OV. Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa. Int Breastfeed J. 2021;16:18.
Consolidated WHO. Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring. Recommendations for a Public Health Approach. Geneva, Swizerland: World Health Organization; 2021.
Bourgi K, Ofner S, Musick B, et al. Weight gain among treatment-naïve persons with HIV receiving dolutegravir in Kenya. J Acquir Immune Defic Syndr. 2022;91:490–496.
Turcksin R, Bel S, Galjaard S, et al. Maternal obesity and breastfeeding intention, initiation, intensity and duration: a systematic review. Matern Child Nutr. 2014;10:166–183.
Evans C, Humphrey JH. Optimal breastfeeding for children born to mothers living with HIV. Lancet Child Adolesc Health. 2020;4:172–174.
Taha TE, Hoover DR, Chen S, et al. Effects of cessation of breastfeeding in HIV-1-Exposed, uninfected children in Malawi. Clin Infect Dis. 2011;53:388–395.