Somé Eric Nagaonlé, Engebretsen Ingunn M S, Nagot Nicolas, Meda Nicolas Y, Vallo Roselyne, Kankasa Chipepo, Tumwine James K, Singata Mandisa, Hofmeyr Justus G, Van de Perre Philippe, Tylleskär Thorkild
Centre for International Health, University of Bergen, Bergen, Norway.
National Health Research Institute, Centre National pour la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso.
PLoS One. 2017 May 9;12(5):e0177259. doi: 10.1371/journal.pone.0177259. eCollection 2017.
Breastfeeding is recommended for infants born to HIV-infected women in low-income settings. Both breastfeeding and HIV-infection are energy demanding. Our objective was to explore how exclusive and predominant breastfeeding changes body mass index (BMI) among breastfeeding HIV1-positive women participating in the ANRS12174 trial (clinical trial no NCT0064026).
HIV-positive women (n = 1 267) with CD4 count >350, intending to breastfeed HIV-negative infants were enrolled from Burkina Faso, South Africa, Uganda and Zambia and counselled on breastfeeding. N = 1 216 were included in the analysis. The trial compared Lamivudine and Lopinavir/Ritonavir as a peri-exposure prophylaxis. We ran a linear mixed-effect model with BMI as the dependent variable and exclusive or predominant breastfeeding duration as the key explanatory variable.
Any breastfeeding or exclusive/predominant) breastfeeding was initiated by 99.6% and 98.6% of the mothers respectively in the first week after birth. The median (interquartile range: IQR) duration of the group that did any breastfeeding or the group that did exclusive /predominant breastfeeding were 9.5 (7.5; 10.6) and 5.8 (5.6; 5.9)) months, respectively. The median (IQR) age, BMI, CD4 count, and HIV viral load at baseline (day 7) were 27 (23.3; 31) years, 23.7 (21.3; 27.0) kg/m2, 530 (432.5; 668.5) cells/μl and 0.1 (0.8; 13.7)1000 copies/mL, respectively. No major change in mean BMI was seen in this cohort over a 50-week period during lactation. The mean change between 26 and 50 weeks after birth was 0.7 kg/m2. Baseline mean BMI (measured on day 7 postpartum) and CD4 count were positively associated with maternal BMI change, with a mean increase of 1.0 kg/m2 (0.9; 1.0) per each additional baseline-BMI kilogram and 0.3 kg/m2 (0.2; 0.5) for each additional CD4 cell/μl, respectively.
Breastfeeding was not negatively correlated with the BMI of HIV-1 infected Sub-Saharan African mothers. However, a higher baseline BMI and a CD4 count >500 cells/μl were associated with maternal BMI during the exclusive/ predominant breastfeeding period. Considering the benefits of breast milk for the infants and the recurrent results from different studies that breastfeeding is not harmful to the HIV-1-infected mothers, this study also supports the WHO 2016 guidelines on infant feeding that mothers living with HIV should breastfeed where formula is not safe for at least 12 months and up to 24 months, given that the right treatment or prophylaxis for the infection is administered. These findings and conclusions cannot be extrapolated to women who are immune-compromised or have AIDS.
在低收入环境中，建议感染艾滋病毒的妇女所生婴儿进行母乳喂养。母乳喂养和艾滋病毒感染都需要消耗能量。我们的目标是探讨在参与ANRS12174试验（临床试验编号NCT0064026）的母乳喂养的HIV-1阳性女性中，纯母乳喂养和主要母乳喂养如何改变体重指数（BMI）。
从布基纳法索、南非、乌干达和赞比亚招募了CD4细胞计数>350且打算母乳喂养艾滋病毒阴性婴儿的HIV阳性女性（n = 1267），并对她们进行母乳喂养咨询。1216名女性纳入分析。该试验比较了拉米夫定和洛匹那韦/利托那韦作为暴露前预防用药。我们以BMI作为因变量，以纯母乳喂养或主要母乳喂养持续时间作为关键解释变量，运行了线性混合效应模型。
分别有99.6%和98.6%的母亲在出生后第一周开始进行任何形式的母乳喂养或纯母乳喂养/主要母乳喂养。进行任何形式母乳喂养组和纯母乳喂养/主要母乳喂养组的中位（四分位间距：IQR）持续时间分别为9.5（7.5；10.6）个月和5.8（5.6；5.9）个月。基线（第7天）时的中位（IQR）年龄、BMI、CD4细胞计数和艾滋病毒病毒载量分别为27（23.3；31）岁、23.7（21.3；27.0）kg/m²、530（432.5；668.5）个细胞/μl和0.1（0.8；13.7）×1000拷贝/mL。在哺乳期的50周内，该队列的平均BMI没有明显变化。出生后26至50周的平均变化为0.7 kg/m²。基线平均BMI（产后第7天测量）和CD4细胞计数与母亲BMI变化呈正相关，每增加1个基线BMI千克，平均增加1.0 kg/m²（0.9；1.0），每增加1个CD4细胞/μl，平均增加0.3 kg/m²（0.2；0.5）。
母乳喂养与撒哈拉以南非洲感染HIV-1的母亲的BMI没有负相关。然而，较高的基线BMI和CD4细胞计数>500个细胞/μl与纯母乳喂养/主要母乳喂养期间的母亲BMI相关。考虑到母乳对婴儿的益处以及不同研究反复表明母乳喂养对感染HIV-1的母亲无害，本研究也支持世界卫生组织2016年关于婴儿喂养的指南，即感染艾滋病毒的母亲在配方奶不安全的情况下应进行母乳喂养，至少12个月，最长24个月，前提是给予正确的感染治疗或预防措施。这些发现和结论不能外推到免疫功能低下或患有艾滋病的女性。
