Somé Eric N, Engebretsen Ingunn M S, Nagot Nicolas, Meda Nicolas, Lombard Carl, Vallo Roselyne, Peries Marianne, Kankasa Chipepo, Tumwine James K, Hofmeyr G Justus, Singata Mandisa, Harper Kim, Van De Perre Philippe, Tylleskar Thorkild
Centre for International Health, University of Bergen, Bergen, Norway.
National Health Research Institute, Centre National pour la Recherche Scientifique et Technologique, 10 BP 250 Ouagadougou, Burkina Faso.
Int Breastfeed J. 2017 May 2;12:22. doi: 10.1186/s13006-017-0112-2. eCollection 2016.
HIV-1 transmission rates have been reduced over the last decade, an estimated 2 million new infections per year arise, including 220,000 paediatric cases. The main post-natal HIV exposure is through breastfeeding, where both its duration and modality (exclusive or not) are associated with postnatal transmission. The ANRS 12174 trial compared HIV-1 postnatal transmission of 2 prophylaxis drugs for infants during lactation (lamivudine and lopinavir-ritonavir). Our objective has been to examine the feeding practices and the determinants of exclusive/ predominant (EPBF) or any breastfeeding among the participants of this trial in Burkina Faso, South Africa, Uganda and Zambia.
Mothers infected with HIV-1 and their uninfected offspring were followed from day 7 after birth for 50 weeks, keeping monthly records of their feeding patterns. Feeding was classified into 3 categories: 1) exclusive breastfeeding during the first six months, only breast-milk being given to infant for 6 months, 2) predominant breastfeeding, breast-milk with liquid-based items being given, and 3) mixed feeding, other non-breast milk or solid food being given in addition to breast milk with or without liquid-based items. The categories were merged into 2 groups: EPBF applying to infants aged <6 months and mixed feeding applying to infants of any age. The feeding patterns have been given as Kaplan-Meier curves. A flexible parametric multiple regression model was used to identify the determinants of the mothers' feeding behaviour.
A total of 1,225 mother-infant pairs provided feeding data from Burkina Faso ( = 204), South Africa ( = 213), Uganda ( = 274) and Zambia ( = 534) between November 2009 and March 2013. The mean maternal age was 27.4 years and the mean BMI was 24.5. 57.7 and 93.9% of mothers initiated breastfeeding within the first hour and first day, respectively. Overall, the median durations of any form of breastfeeding and EPBF were 40.6, and 20.9 weeks, respectively. Babies randomized to the lopinavir/ritonavir group in South Africa tended to do less EPBF than those in the lamivudine group. Overall the group of mothers aged between 25 and 30 years, those married, employed or multiparous tended to stop early EPBF. Mothers living in Uganda or Zambia, those aged between 25 -30 years, better educated (at least secondary school level), employed or having undergone C-section stopped any breastfeeding early.
There is a need to improve breastfeeding and complementary feeding practices of children, particularly those exposed to HIV and anti-retrovirals, taking into account context and socio-demographic factors.
Clinical trial registration: NCT00640263.
在过去十年中，HIV-1传播率有所下降，但每年仍有估计200万新发感染病例，其中包括22万例儿科病例。产后HIV的主要传播途径是母乳喂养，母乳喂养的持续时间和方式（是否纯母乳喂养）均与产后传播有关。ANRS 12174试验比较了两种预防药物（拉米夫定和洛匹那韦-利托那韦）对哺乳期婴儿HIV-1产后传播的影响。我们的目标是研究布基纳法索、南非、乌干达和赞比亚该试验参与者的喂养方式以及纯母乳喂养/主要母乳喂养（EPBF）或任何形式母乳喂养的决定因素。
对感染HIV-1的母亲及其未感染的后代从出生后第7天开始随访50周，每月记录其喂养模式。喂养方式分为三类：1）前六个月纯母乳喂养，即婴儿仅接受母乳6个月；2）主要母乳喂养，即除母乳外还给予流质食物；3）混合喂养，除母乳（有或没有流质食物）外还给予其他非母乳或固体食物。这些类别合并为两组：适用于6个月以下婴儿的EPBF和适用于任何年龄婴儿的混合喂养。喂养模式以Kaplan-Meier曲线表示。使用灵活的参数多元回归模型来确定母亲喂养行为的决定因素。
2009年11月至2013年3月期间，共有1225对母婴提供了喂养数据，分别来自布基纳法索（n = 204）、南非（n = 213）、乌干达（n = 274）和赞比亚（n = 534）。母亲的平均年龄为27.4岁，平均BMI为24.5。分别有57.7%和93.9%的母亲在产后第一小时和第一天开始母乳喂养。总体而言，任何形式母乳喂养和EPBF的中位持续时间分别为40.6周和20.9周。在南非，随机分配到洛匹那韦/利托那韦组的婴儿进行EPBF的情况往往比拉米夫定组少。总体而言，年龄在25至30岁之间、已婚、就业或多产的母亲往往较早停止EPBF。生活在乌干达或赞比亚、年龄在25 - 30岁之间、受教育程度较高（至少中学水平）、就业或接受过剖宫产的母亲较早停止任何形式的母乳喂养。
需要改善儿童的母乳喂养和辅食添加方式，尤其是那些暴露于HIV和抗逆转录病毒药物的儿童，同时要考虑到具体情况和社会人口学因素。
临床试验注册：NCT00640263。
