Mbori-Ngacha D, Nduati R, John G, Reilly M, Richardson B, Mwatha A, Ndinya-Achola J, Bwayo J, Kreiss J
Department of Paediatrics, University of Nairobi, Kenya.
JAMA. 2001 Nov 21;286(19):2413-20. doi: 10.1001/jama.286.19.2413.
Breastfeeding among women infected with human immunodeficiency virus type 1 (HIV-1) is associated with substantial risk of HIV-1 transmission, but little is known about the morbidity risks associated with formula feeding in infants of HIV-1-infected women in resource-poor settings.
To compare morbidity, nutritional status, mortality adjusted for HIV-1 status, and cause of death among formula-fed and breastfed infants of HIV-1-infected women.
Randomized clinical trial conducted between 1992 and 1998.
Four antenatal clinics in Nairobi, Kenya.
Of 401 live-born, singleton, or first-born twin infants of randomized HIV-1-seropositive mothers, 371 were included in the analysis of morbidity and mortality.
Mothers were randomly assigned either to use formula (n = 186) or to breastfeed (n = 185) their infants.
Mortality rates, adjusted for HIV-1 infection status; morbidity; and nutritional status during the first 2 years of life.
Two-year estimated mortality rates among infants were similar in the formula-feeding and breastfeeding arms (20.0% vs 24.4%; hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.5-1.3), even after adjusting for HIV-1 infection status (HR, 1.1; 95% CI, 0.7-1.7). Infection with HIV-1 was associated with a 9.0-fold increased mortality risk (95% CI, 5.3-15.3). The incidence of diarrhea during the 2 years of follow-up was similar in formula and breastfeeding arms (155 vs 149 per 100 person-years, respectively). The incidence of pneumonia was identical in the 2 groups (62 per 100 person-years), and there were no significant differences in incidence of other recorded illnesses. Infants in the breastfeeding arm tended to have better nutritional status, significantly so during the first 6 months of life.
In this randomized clinical trial, infants assigned to be formula fed or breastfed had similar mortality rates and incidence of diarrhea and pneumonia during the first 2 years of life. However, HIV-1-free survival at 2 years was significantly higher in the formula arm. With appropriate education and access to clean water, formula feeding can be a safe alternative to breastfeeding for infants of HIV-1-infected mothers in a resource-poor setting.
感染1型人类免疫缺陷病毒（HIV-1）的女性进行母乳喂养会带来较高的HIV-1传播风险，但在资源匮乏地区，对于感染HIV-1的女性所生婴儿采用配方奶喂养的发病风险却知之甚少。
比较感染HIV-1的女性所生配方奶喂养婴儿和母乳喂养婴儿的发病率、营养状况、根据HIV-1感染状况调整后的死亡率及死亡原因。
1992年至1998年进行的随机临床试验。
肯尼亚内罗毕的四家产前诊所。
401名HIV-1血清学阳性母亲的活产单胎或双胎中的头胎婴儿，371名纳入发病率和死亡率分析。
母亲们被随机分配用配方奶喂养（n = 186）或母乳喂养（n = 185）其婴儿。
根据HIV-1感染状况调整后的死亡率；发病率；以及生命最初2年的营养状况。
配方奶喂养组和母乳喂养组婴儿的2年估计死亡率相似（20.0%对24.4%；风险比[HR]，0.8；95%置信区间[CI]，0.5 - 1.3），即使在根据HIV-1感染状况进行调整后（HR，1.1；95% CI，0.7 - 1.7）。感染HIV-1与死亡风险增加9.0倍相关（95% CI，5.3 - 15.3）。随访2年期间，配方奶喂养组和母乳喂养组腹泻发病率相似（分别为每100人年155例对149例）。两组肺炎发病率相同（每100人年62例），其他记录疾病的发病率无显著差异。母乳喂养组婴儿的营养状况往往更好，在生命最初6个月尤为明显。
在这项随机临床试验中，被分配进行配方奶喂养或母乳喂养的婴儿在生命最初2年的死亡率以及腹泻和肺炎发病率相似。然而，配方奶喂养组2岁时未感染HIV-1的存活率显著更高。在资源匮乏地区，通过适当的教育并能获得清洁水，对于感染HIV-1的母亲所生婴儿，配方奶喂养可以是母乳喂养的一种安全替代方式。
