Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi.
J Acquir Immune Defic Syndr. 2010 Jan;53(1):6-13. doi: 10.1097/QAI.0b013e3181bd5a47.
We assessed gastroenteritis (GE) burden in 2 randomized trials conducted in Malawi to reduce postnatal HIV transmission before and after World Health Organization recommendations regarding exclusive breastfeeding for HIV-exposed infants were adopted. The 2 trials were the nevirapine/AZT (NVAZ, 2000-2003 with prolonged breastfeeding) and the Postexposure Prophylaxis to the Infant (PEPI, 2004-2007 with breastfeeding cessation by 6 months).
From NVAZ and PEPI trials data, GE frequency through age 12 months among HIV-negative exposed infants was evaluated. Overall and GE-related cumulative mortality rates were estimated using Kaplan-Meier curves.
The frequency of at least one GE-related hospitalization was greater in PEPI vs. NVAZ after age 6 months (respectively, 2.9% vs. 0.1%, at 7-9 months and 1.6% vs. 0.2% at 10-12 months, P < 0.001). Cumulative GE-related mortality was significantly higher in PEPI than in NVAZ after age 6 months; at ages 9 and 12 months GE-related mortality was 19 and 24 per 1000 infants in PEPI vs. 7 and 12 per 1000 infants in NVAZ (P = 0.0002).
Early weaning was associated with increased risk of severe GE and GE-related mortality among HIV-exposed infants. Strategies are urgently needed which allow longer breastfeeding while reducing the risk of HIV breast milk transmission in resource-limited settings.
我们评估了在马拉维进行的 2 项随机试验中的肠胃炎（GE）负担，以在世界卫生组织（WHO）建议在 HIV 暴露婴儿中采用纯母乳喂养之前和之后降低产后 HIV 传播。这 2 项试验分别是奈韦拉平/齐多夫定（NVAZ，2000-2003 年，延长母乳喂养）和婴儿暴露后预防（PEPI，2004-2007 年，6 个月时停止母乳喂养）。
根据 NVAZ 和 PEPI 试验的数据，评估了 HIV 阴性暴露婴儿在 12 个月龄时的 GE 频率。使用 Kaplan-Meier 曲线估计总死亡率和与 GE 相关的累积死亡率。
在 6 个月后，PEPI 中至少有一次与 GE 相关的住院治疗的频率高于 NVAZ（分别为 7-9 个月时为 2.9%对 0.1%，10-12 个月时为 1.6%对 0.2%，P<0.001）。在 6 个月后，PEPI 中与 GE 相关的累积死亡率明显高于 NVAZ；在 9 个月和 12 个月时，PEPI 中与 GE 相关的死亡率分别为每 1000 名婴儿 19 例和 24 例，而 NVAZ 中分别为每 1000 名婴儿 7 例和 12 例（P=0.0002）。
早期断奶与 HIV 暴露婴儿中严重 GE 和 GE 相关死亡风险增加相关。在资源有限的环境中，迫切需要制定允许更长时间母乳喂养同时降低 HIV 母乳传播风险的策略。
