Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
J Acquir Immune Defic Syndr. 2024 Jan 1;95(1):10-17. doi: 10.1097/QAI.0000000000003306.
Lifelong antiretroviral treatment (ART) use is recommended for pregnant and breastfeeding (BF) women living with HIV (WLWH) to prevent perinatal HIV transmission and improve maternal health. We address 2 objectives in this analysis: (1) determine timing and factors associated with BF cessation and (2) assess the impact of BF on health of WLWH on ART.
This multicountry study included 8 sites in Uganda, Malawi, Zimbabwe, and South Africa.
This was a prospective study of WLWH on lifelong ART. These women initially participated from 2011 to 2016 in a randomized clinical trial (PROMISE) to prevent perinatal HIV transmission and subsequently reenrolled in an observational study (PROMOTE, 2016-2021) to assess ART adherence, safety, and impact.
The PROMOTE cohort included 1987 women on ART. Of them, 752 breastfed and were included in analyses of objective 1; all women were included in analyses of objective 2. The median time to BF cessation varied by country (11.2-19.7 months). Country of residence, age, and health status of women were significantly associated with time to BF cessation (compared with Zimbabwe: Malawi, adjusted hazard ratio [aHR] 0.50, 95% confidence interval [95% CI]: 0.40 to 0.62, P < 0.001; South Africa, aHR 1.49, 95% CI: 1.11 to 2.00, P = 0.008; and Uganda, aHR 1.77, 95% CI: 1.37 to 2.29, P < 0.001). Women who breastfed had lower risk of being "unwell" compared with women who never breastfed (adjusted rate ratio 0.87, 95% CI: 0.81 to 0.95 P = 0.030).
Women on lifelong ART should be encouraged to continue BF with no concern for their health. Time to BF cessation should be monitored for proper counseling in each country.
建议感染艾滋病毒的孕妇和哺乳期妇女（HIVW）终身接受抗逆转录病毒治疗（ART），以预防围产期 HIV 传播并改善母婴健康。本分析旨在实现以下两个目标：（1）确定停止母乳喂养的时间和相关因素；（2）评估母乳喂养对接受 ART 的 HIVW 健康的影响。
本研究包括乌干达、马拉维、津巴布韦和南非的 8 个地点。
这是一项针对接受终身 ART 的 HIVW 的前瞻性研究。这些妇女最初于 2011 年至 2016 年参加了预防围产期 HIV 传播的随机临床试验（PROMISE），随后于 2016 年至 2021 年重新参加了评估 ART 依从性、安全性和影响的观察性研究（PROMOTE）。
PROMOTE 队列纳入了 1987 名接受 ART 的妇女。其中，752 名母乳喂养者纳入了第 1 个目标的分析；所有妇女均纳入了第 2 个目标的分析。停止母乳喂养的中位时间因国家而异（11.2-19.7 个月）。妇女居住地、年龄和健康状况与停止母乳喂养的时间显著相关（与津巴布韦相比：马拉维，调整后的危害比 [aHR] 0.50，95%置信区间 [95%CI]：0.40 至 0.62，P < 0.001；南非，aHR 1.49，95%CI：1.11 至 2.00，P = 0.008；乌干达，aHR 1.77，95%CI：1.37 至 2.29，P < 0.001）。与从未母乳喂养的妇女相比，母乳喂养的妇女身体不适的风险较低（调整后的比率比 0.87，95%CI：0.81 至 0.95，P = 0.030）。
应鼓励接受终身 ART 的妇女进行母乳喂养，无需担心自身健康。应监测停止母乳喂养的时间，以便在每个国家提供适当的咨询。
