Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
PLoS One. 2022 Aug 2;17(8):e0269835. doi: 10.1371/journal.pone.0269835. eCollection 2022.
World Health Organization recommends promoting breastfeeding without restricting its duration among HIV-positive women on lifelong antiretroviral treatment (ART). There is little data on breastfeeding duration and mother to child transmission (MTCT) beyond 24 months. We compared the duration of breastfeeding in HIV-exposed and HIV-unexposed children and we identified factors associated with postpartum-MTCT in a semi-rural population of Mozambique.
This cross-sectional assessment was conducted from October-2017 to April-2018. Mothers who had given birth within the previous 48-months in the Manhiça district were randomly selected to be surveyed and to receive an HIV-test along with their children. Postpartum MTCT was defined as children with an initial HIV positive result beyond 6 weeks of life who initiated breastfeeding if they had a first negative PCR result during the first 6 weeks of life or whose mother had an estimated date of infection after the child's birth. Cumulative incidence accounting for right-censoring was used to compare breastfeeding duration in HIV-exposed and unexposed children. Fine-Gray regression was used to assess factors associated with postpartum-MTCT.
Among the 5000 mother-child pairs selected, 69.7% (3486/5000) were located and enrolled. Among those, 27.7% (967/3486) children were HIV-exposed, 62.2% (2169/3486) were HIV-unexposed and for 10.0% (350/3486) HIV-exposure was unknown. Median duration of breastfeeding was 13.0 (95%CI:12.0-14.0) and 20.0 (95%CI:19.0-20.0) months among HIV-exposed and HIV-unexposed children, respectively (p<0.001). Of the 967 HIV-exposed children, 5.3% (51/967) were HIV-positive at the time of the survey. We estimated that 27.5% (14/51) of the MTCT occurred during pregnancy and delivery, 49.0% (2551) postpartum-MTCT and the period of MTCT remained unknown for 23.5% (12/51) of children. In multivariable analysis, mothers' ART initiation after the date of childbirth was associated (aSHR:9.39 [95%CI:1.75-50.31], p = 0.001), however breastfeeding duration was not associated with postpartum-MTCT (aSHR:0.99 [95%CI:0.96-1.03], p = 0.707).
The risk for postpartum MTCT was nearly tenfold higher in women newly diagnosed and/or initiating ART postpartum. This highlights the importance of sustained HIV screening and prompt ART initiation in postpartum women in Sub-Saharan African countries. Under conditions where HIV-exposed infants born to mothers on ART receive adequate PMTCT, extending breastfeeding duration may be recommended.
世界卫生组织建议在接受终身抗逆转录病毒治疗（ART）的 HIV 阳性妇女中，提倡无限制母乳喂养时间。在 24 个月之后，关于母乳喂养时间和母婴传播（MTCT）的资料很少。我们比较了 HIV 暴露和未暴露儿童的母乳喂养时间，并在莫桑比克半农村地区确定了与产后 MTCT 相关的因素。
这项横断面评估于 2017 年 10 月至 2018 年 4 月进行。在马希奇区过去 48 个月内分娩的母亲被随机选择接受调查，并与子女一起接受 HIV 检测。产后 MTCT 定义为在出生后 6 周内初次 HIV 阳性结果的儿童，如果在出生后前 6 周内首次 PCR 结果为阴性或其母亲的估计感染日期在儿童出生后，则开始母乳喂养。使用 Fine-Gray 回归评估与产后 MTCT 相关的因素。
在选定的 5000 对母婴中，有 69.7%（3486/5000）被定位并纳入研究。其中，27.7%（967/3486）的儿童为 HIV 暴露，62.2%（2169/3486）为 HIV 未暴露，10.0%（350/3486）的 HIV 暴露情况未知。HIV 暴露和未暴露儿童的母乳喂养中位数分别为 13.0（95%CI：12.0-14.0）和 20.0（95%CI：19.0-20.0）个月（p<0.001）。在 967 名 HIV 暴露儿童中，有 5.3%（51/967）在调查时 HIV 阳性。我们估计，27.5%（14/51）的 MTCT 发生在妊娠和分娩期间，49.0%（2551）发生在产后 MTCT，23.5%（12/51）的 MTCT 时间仍不清楚。多变量分析显示，母亲在分娩后开始 ART（aSHR：9.39 [95%CI：1.75-50.31]，p = 0.001）与产后 MTCT 相关，而母乳喂养时间与产后 MTCT 无关（aSHR：0.99 [95%CI：0.96-1.03]，p = 0.707）。
在新诊断和/或产后开始接受 ART 的妇女中，产后 MTCT 的风险几乎高十倍。这突显了在撒哈拉以南非洲国家，持续进行 HIV 筛查和及时为产后妇女启动 ART 的重要性。在接受抗逆转录病毒药物治疗的 HIV 暴露婴儿获得充分的产后母婴传播预防措施的情况下，延长母乳喂养时间可能是推荐的。
