母乳喂养对撒哈拉以南非洲地区感染艾滋病毒的母亲及其子女健康的影响。

The impact of breastfeeding on the health of HIV-positive mothers and their children in sub-Saharan Africa.

作者信息

Taha Taha E, Kumwenda Newton I, Hoover Donald R, Kafulafula George, Fiscus Susan A, Nkhoma Chiwawa, Chen Shu, Broadhead Robin L

机构信息

Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.

出版信息

Bull World Health Organ. 2006 Jul;84(7):546-54. doi: 10.2471/blt.05.027664.

DOI:10.2471/blt.05.027664

PMID:16878228

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2627383/

Abstract

OBJECTIVE

We assessed the impact of breastfeeding by women infected with human immunodeficiency virus (HIV)-1 on their morbidity and risk of mortality and on the mortality of their children.

METHODS

We analysed longitudinal data from two previous randomized clinical trials of mother-to-child transmission of HIV conducted between April 2000 and March 2003 in the Republic of Malawi, Africa. Mothers infected with HIV, and their newborns, were enrolled at the time of their child's birth; they then returned for follow-up visits when the child was aged 1 week, 6-8 weeks and then 3, 6, 9, 15, 18, 21 and 24 months. Patterns of breastfeeding (classified as exclusive, mixed or no breastfeeding), maternal morbidity and mortality, and mortality among their children were assessed at each visit. Descriptive and multivariate analyses were performed to determine the association between breastfeeding and maternal and infant outcomes.

FINDINGS

A total of 2000 women infected with HIV were enrolled in the original studies. During the 2 years after birth, 44 (2.2%) mothers and 310 (15.5%) children died. (Multiple births were excluded.) The median duration of breastfeeding was 18 months (interquartile range (IQR)=9.0-22.5), exclusive breastfeeding 2 months (IQR=2-3) and mixed feeding 12 months (IQR=6-18). Breastfeeding patterns were not significantly associated with maternal mortality or morbidity after adjusting for maternal viral load and other covariates. Breastfeeding was associated with reduced mortality among infants and children: the adjusted hazard ratio for overall breastfeeding was 0.44 (95% confidence interval (CI)=0.28-0.70), for mixed feeding 0.45 (95% CI=0.28-0.71) and for exclusive breastfeeding 0.40 (95% CI=0.22-0.72). These protective effects were seen both in infants who were infected with HIV and those who were not.

CONCLUSION

Breastfeeding by women infected with HIV was not associated with mortality or morbidity; it was associated with highly significant reductions in mortality among their children.

摘要

目的

我们评估了感染人类免疫缺陷病毒1型（HIV-1）的女性进行母乳喂养对其发病率、死亡风险以及子女死亡率的影响。

方法

我们分析了此前在非洲马拉维共和国于2000年4月至2003年3月期间开展的两项关于HIV母婴传播的随机临床试验的纵向数据。感染HIV的母亲及其新生儿在孩子出生时登记入组；之后当孩子1周龄、6 - 8周龄，然后3、6、9、15、18、21和24月龄时返回进行随访。每次随访时评估母乳喂养模式（分为纯母乳喂养、混合喂养或不进行母乳喂养）、母亲的发病率和死亡率以及其子女的死亡率。进行描述性和多变量分析以确定母乳喂养与母婴结局之间的关联。

研究结果

最初的研究共纳入了2000名感染HIV的女性。出生后的2年中，44名（2.2%）母亲和310名（15.5%）儿童死亡。（排除了多胞胎。）母乳喂养的中位持续时间为18个月（四分位间距（IQR）=9.0 - 22.5），纯母乳喂养2个月（IQR = 2 - 3），混合喂养12个月（IQR = 6 - 18）。在对母亲病毒载量和其他协变量进行调整后，母乳喂养模式与母亲死亡率或发病率无显著关联。母乳喂养与婴幼儿死亡率降低相关：总体母乳喂养的调整后风险比为0.44（95%置信区间（CI）=0.28 - 0.70），混合喂养为0.45（95% CI = 0.28 - 0.71），纯母乳喂养为0.40（95% CI = 0.22 - 0.72）。在感染HIV的婴儿和未感染HIV的婴儿中均观察到了这些保护作用。