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HIV-free survival according to the early infant-feeding practices; a retrospective study in an anti-retroviral therapy programme in Makurdi, Nigeria.

Anígilájé EA, Dabit OJ, Olutola A, Ageda B, Aderibigbe SA - BMC Infect. Dis. (2015)

Bottom Line: The overall HFS was 94.4% at 3 months and this declined significantly to 87.1% at the 18 months of age (p-value=0.000).A higher and significant drop off in HFS at the two time points occurred between infants on EBMS (12.9%) compared to infants on EBF (4.9%), p-value of 0.002, but not between infants on MF (5.9%) and EBMS, p-value of 0.114 and those on MF and EBF, p-value of 0.758.For a better HFS in our setting; MF must be avoided, efforts to deliver babies at term in mothers with reduced viral load are advocated and EBF must be promoted as the safest and the most feasible mode of infant-feeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics, Benue State University, Makurdi, Benue State, Nigeria. demolaanigilaje@yahoo.co.uk.

ABSTRACT

Background: In Nigeria, reports of the outcomes of prevention of mother to child transmission of HIV (PMTCT) interventions had been limited to the MTCT rates of HIV, with no information on HIV-free survival (HFS) in the HIV-exposed infants over time.

Methods: A retrospective study between June 2008 and December 2011 at the Federal Medical Centre, Makurdi, Nigeria comparing HFS rates at 3 and 18 months according to the infant feeding pattern at the 6th week of life. HFS was assessed by Kaplan-Meier analysis and association of maternal and infant variables and risk of HIV acquisition or death was tested in a Cox regression analysis.

Results: 801 HIV uninfected infants at 6 weeks of life were studied in accordance with their reported cumulative feeding pattern. This includes 196 infants on exclusive breast feeding (EBF); 544 on exclusive breast milk substitute (EBMS) feeding and 61 on mixed feeding (MF). The overall HFS was 94.4% at 3 months and this declined significantly to 87.1% at the 18 months of age (p-value=0.000). The infants on MF had the lowest HFS rates of 75.7% at 3 months and 69.8% at 18 months. The HFS rate for infants on EBF was 97.4% at 3 months and 92.5% at 18 month whilst infants on EBMS had HFS of 99.1% at 3 months and 86.2% at 18 months. A higher and significant drop off in HFS at the two time points occurred between infants on EBMS (12.9%) compared to infants on EBF (4.9%), p-value of 0.002, but not between infants on MF (5.9%) and EBMS, p-value of 0.114 and those on MF and EBF, p-value of 0.758. In Cox regression multivariate analyses; MF, gestational age of ˂37 weeks, and a high pre-delivery maternal viral load were consistently associated with HIV infection or death at 3 months and 18 months (p˂.05).

Conclusion: For a better HFS in our setting; MF must be avoided, efforts to deliver babies at term in mothers with reduced viral load are advocated and EBF must be promoted as the safest and the most feasible mode of infant-feeding.

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Related in: MedlinePlus

Schematic diagram of the follow-up of the infants in the study. Legends: LTFP: loss to follow up; EBF: exclusive breast feeding; EBMS: exclusive breast milk substitute feeding; MF: mixed feeding; PMTCT; prevention of mother to child transmission of HIV.
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Fig1: Schematic diagram of the follow-up of the infants in the study. Legends: LTFP: loss to follow up; EBF: exclusive breast feeding; EBMS: exclusive breast milk substitute feeding; MF: mixed feeding; PMTCT; prevention of mother to child transmission of HIV.

Mentions: Figure 1 is the schematic diagram of the follow-up of the infants in the study. 855 infants were born alive to HIV-infected mothers but only 801 infants who were DNA/PCR negative at the 6th week were included in the study. Reasons for the exclusion of the other 54 infants were as shown in Figure 1. Among these 801 infants, 206 mothers had initially opted for EBF and 595 mothers for EBMS within the first 24 hours of birth (i.e., intention -to -feed). However, by the 6th week of follow-up, 61 infants were already mixed- fed. This included 10 of the initial exclusive breast-feeders (i.e., EBF uptake of 95.1%) and 51 of the initial replacement feeders (EBMS uptake of 91.4%). Among the MF infants, the infant feeds in addition to the mix of breast milk/BMS (43 infants, 70.5%) were maize gruels in 12 infants, (19.6%, 12/61) and cocoa beverages (Milo®) in 6 infants, (9.8%, 6/61). At the 3rd month of life, after excluding infants that were lost to follow-up and those that died, 94.9% (186/196) of the infants were still on EBF, 95.8% of the infants were still on EBMS, and 78.7% were still mix-feeding. Same proportions were on these feeding patterns by the 6th month.Figure 1


HIV-free survival according to the early infant-feeding practices; a retrospective study in an anti-retroviral therapy programme in Makurdi, Nigeria.

Anígilájé EA, Dabit OJ, Olutola A, Ageda B, Aderibigbe SA - BMC Infect. Dis. (2015)

Schematic diagram of the follow-up of the infants in the study. Legends: LTFP: loss to follow up; EBF: exclusive breast feeding; EBMS: exclusive breast milk substitute feeding; MF: mixed feeding; PMTCT; prevention of mother to child transmission of HIV.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4375932&req=5

Fig1: Schematic diagram of the follow-up of the infants in the study. Legends: LTFP: loss to follow up; EBF: exclusive breast feeding; EBMS: exclusive breast milk substitute feeding; MF: mixed feeding; PMTCT; prevention of mother to child transmission of HIV.
Mentions: Figure 1 is the schematic diagram of the follow-up of the infants in the study. 855 infants were born alive to HIV-infected mothers but only 801 infants who were DNA/PCR negative at the 6th week were included in the study. Reasons for the exclusion of the other 54 infants were as shown in Figure 1. Among these 801 infants, 206 mothers had initially opted for EBF and 595 mothers for EBMS within the first 24 hours of birth (i.e., intention -to -feed). However, by the 6th week of follow-up, 61 infants were already mixed- fed. This included 10 of the initial exclusive breast-feeders (i.e., EBF uptake of 95.1%) and 51 of the initial replacement feeders (EBMS uptake of 91.4%). Among the MF infants, the infant feeds in addition to the mix of breast milk/BMS (43 infants, 70.5%) were maize gruels in 12 infants, (19.6%, 12/61) and cocoa beverages (Milo®) in 6 infants, (9.8%, 6/61). At the 3rd month of life, after excluding infants that were lost to follow-up and those that died, 94.9% (186/196) of the infants were still on EBF, 95.8% of the infants were still on EBMS, and 78.7% were still mix-feeding. Same proportions were on these feeding patterns by the 6th month.Figure 1

Bottom Line: The overall HFS was 94.4% at 3 months and this declined significantly to 87.1% at the 18 months of age (p-value=0.000).A higher and significant drop off in HFS at the two time points occurred between infants on EBMS (12.9%) compared to infants on EBF (4.9%), p-value of 0.002, but not between infants on MF (5.9%) and EBMS, p-value of 0.114 and those on MF and EBF, p-value of 0.758.For a better HFS in our setting; MF must be avoided, efforts to deliver babies at term in mothers with reduced viral load are advocated and EBF must be promoted as the safest and the most feasible mode of infant-feeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics, Benue State University, Makurdi, Benue State, Nigeria. demolaanigilaje@yahoo.co.uk.

ABSTRACT

Background: In Nigeria, reports of the outcomes of prevention of mother to child transmission of HIV (PMTCT) interventions had been limited to the MTCT rates of HIV, with no information on HIV-free survival (HFS) in the HIV-exposed infants over time.

Methods: A retrospective study between June 2008 and December 2011 at the Federal Medical Centre, Makurdi, Nigeria comparing HFS rates at 3 and 18 months according to the infant feeding pattern at the 6th week of life. HFS was assessed by Kaplan-Meier analysis and association of maternal and infant variables and risk of HIV acquisition or death was tested in a Cox regression analysis.

Results: 801 HIV uninfected infants at 6 weeks of life were studied in accordance with their reported cumulative feeding pattern. This includes 196 infants on exclusive breast feeding (EBF); 544 on exclusive breast milk substitute (EBMS) feeding and 61 on mixed feeding (MF). The overall HFS was 94.4% at 3 months and this declined significantly to 87.1% at the 18 months of age (p-value=0.000). The infants on MF had the lowest HFS rates of 75.7% at 3 months and 69.8% at 18 months. The HFS rate for infants on EBF was 97.4% at 3 months and 92.5% at 18 month whilst infants on EBMS had HFS of 99.1% at 3 months and 86.2% at 18 months. A higher and significant drop off in HFS at the two time points occurred between infants on EBMS (12.9%) compared to infants on EBF (4.9%), p-value of 0.002, but not between infants on MF (5.9%) and EBMS, p-value of 0.114 and those on MF and EBF, p-value of 0.758. In Cox regression multivariate analyses; MF, gestational age of ˂37 weeks, and a high pre-delivery maternal viral load were consistently associated with HIV infection or death at 3 months and 18 months (p˂.05).

Conclusion: For a better HFS in our setting; MF must be avoided, efforts to deliver babies at term in mothers with reduced viral load are advocated and EBF must be promoted as the safest and the most feasible mode of infant-feeding.

Show MeSH
Related in: MedlinePlus