Bork Kirsten A, Cournil Amandine, Read Jennifer S, Newell Marie-Louise, Cames Cécile, Meda Nicolas, Luchters Stanley, Mbatia Grace, Naidu Kevindra, Gaillard Philippe, de Vincenzi Isabelle
From the Institut de Recherche pour le Développement (IRD), UMI233 IRD/Université de Montpellier 1, Montpellier, France (KAB, AC, and CC); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD (JSR); the Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa (M-LN); the Centre Muraz, Bobo-Dioulasso, Burkina Faso (NM); the International Centre for Reproductive Health, Mombasa, Kenya (SL); the Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya (GM); the University of KwaZulu-Natal, Durban, South African Republic (KN); and the WHO, Reproductive Health and Research, Geneva, Switzerland (PG and IdV).
Am J Clin Nutr. 2014 Dec;100(6):1559-68. doi: 10.3945/ajcn.113.082149. Epub 2014 Oct 22.
Refraining from breastfeeding to prevent HIV transmission has been associated with increased morbidity and mortality in HIV-exposed African infants.
The objective was to assess risks of common and serious infectious morbidity by feeding mode in HIV-exposed, uninfected infants ≤6 mo of age with special attention to the issue of reverse causality.
HIV-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the prevention of mother-to-child transmission Kesho Bora trial and counseled to either breastfeed exclusively and cease by 6 mo postpartum or formula feed exclusively. Maternal-reported morbidity (fever, diarrhea, and vomiting) and serious infectious events (SIEs) (gastroenteritis and lower respiratory tract infections) were investigated for 751 infants for 2 age periods (0-2.9 and 3-6 mo) by using generalized linear mixed models with breastfeeding as a time-dependent variable and adjustment for study site, maternal education, economic level, and cotrimoxazole prophylaxis.
Reported morbidity was not significantly higher in nonbreastfed compared with breastfed infants [OR: 1.31 (95% CI: 0.97, 1.75) and 1.21 (0.90, 1.62) at 0-2.9 and 3-6 mo of age, respectively]. Between 0 and 2.9 mo of age, never-breastfed infants had increased risks of morbidity compared with those of infants who were exclusively breastfed (OR: 1.49; 95% CI: 1.01, 2.2; P = 0.042). The adjusted excess risk of SIEs in nonbreastfed infants was large between 0 and 2.9 mo (OR: 6.0; 95% CI: 2.2, 16.4; P = 0.001). Between 3 and 6 mo, the OR for SIEs was sensitive to the timing of breastfeeding status, i.e., 4.3 (95% CI: 1.2, 15.3; P = 0.02) when defined at end of monthly intervals and 2.0 (95% CI: 0.8, 5.0; P = 0.13) when defined at the beginning of intervals. Of 52 SIEs, 3 mothers reported changes in feeding mode during the SIE although none of the mothers ceased breastfeeding completely.
Not breastfeeding was associated with increased risk of serious infections especially between 0 and 2.9 mo of age. The randomized controlled trial component of the Kesho Bora study was registered at Current Controlled Trials (www.controlled-trials.com) as ISRCTN71468401.
为预防艾滋病毒传播而避免母乳喂养与非洲艾滋病毒暴露婴儿的发病率和死亡率上升有关。
评估6个月及以下艾滋病毒暴露且未感染婴儿因喂养方式导致的常见和严重感染性疾病发病风险，特别关注反向因果关系问题。
来自布基纳法索、肯尼亚和南非5个地点的感染艾滋病毒的孕妇参加了预防母婴传播的“凯索博拉”试验，并接受咨询，建议她们要么纯母乳喂养并在产后6个月停止，要么完全用配方奶喂养。通过使用广义线性混合模型，将母乳喂养作为时间依赖变量，并对研究地点、母亲教育程度、经济水平和复方新诺明预防措施进行调整，对751名婴儿在2个年龄阶段（0 - 2.9个月和3 - 6个月）的母亲报告的发病率（发热、腹泻和呕吐）和严重感染事件（SIEs，即胃肠炎和下呼吸道感染）进行了调查。
与母乳喂养的婴儿相比，非母乳喂养婴儿报告的发病率没有显著更高[分别在0 - 2.9个月和3 - 6个月龄时，比值比（OR）：1.31（95%置信区间：0.97，1.75）和1.21（0.90，1.62）]。在0至2.9个月龄之间，从未母乳喂养的婴儿与纯母乳喂养的婴儿相比，发病风险增加（OR：1.49；95%置信区间：1.01，2.2；P = 0.042）。在0至2.9个月之间，非母乳喂养婴儿SIEs的调整后超额风险很大（OR：6.0；95%置信区间：2.2，16.4；P = 0.001）。在3至6个月之间，SIEs的OR对母乳喂养状态的定义时间敏感，即在每月间隔结束时定义为4.3（95%置信区间：1.2，15.3；P = 0.02），在间隔开始时定义为2.0（95%置信区间：0.8，5.0；P = 0.13）。在52例SIEs中，3名母亲报告在SIE期间喂养方式有变化，尽管没有母亲完全停止母乳喂养。
不进行母乳喂养与严重感染风险增加有关，尤其是在0至2.9个月龄之间。凯索博拉研究的随机对照试验部分已在“当前对照试验”（www.controlled-trials.com）注册，注册号为ISRCTN71468401。
