Differential Effects of Early Weaning for HIV-Free Survival of Children Born to HIV-Infected Mothers by Severity of Maternal Disease 英文参考文献.docVIP

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Differential Effects of Early Weaning for HIV-Free Survival of Children Born to HIV-Infected Mothers by Severity of Maternal Disease 英文参考文献.doc

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Differential Effects of Early Weaning for HIV-Free Survival of Children Born to HIV-Infected Mothers by Severity of Maternal Disease 英文参考文献

DifferentialEffectsofEarlyWeaningforHIV-FreeSurvival ofChildrenBorntoHIV-InfectedMothersbySeverityof MaternalDisease LouiseKuhn1*,GraceM.Aldrovandi2,MosesSinkala3,ChipepoKankasa4,KatherineSemrau5 ,Prisca Kasonde4,MwiyaMwiya4,Wei-YannTsai6,DonaldM.Thea5 fortheZambiaExclusiveBreastfeeding Study(ZEBS) 1GertrudeH.SergievskyCenter,DepartmentofEpidemiology,MailmanSchoolofPublicHealth,ColumbiaUniversity,NewYork,NewYork,UnitedStates ofAmerica, 2DepartmentofPediatrics,Children’sHospitalLosAngeles,UniversityofSouthernCalifornia,LosAngeles,California,UnitedStatesofAmerica,3LusakaDistrictHealth ManagementTeam,Lusaka,Zambia,4UniversityTeachingHospital,UniversityofZambia,Lusaka,Zambia,5CenterforInternationalHealthandDevelopment,Boston UniversitySchoolofPublicHealth,Boston,Massachusetts,UnitedStatesofAmerica,6DepartmentofBiostatistics,MailmanSchoolofPublicHealth,ColumbiaUniversity, NewYork,NewYork,UnitedStatesofAmerica Abstract Background: We previously reported no benefit of early weaning for HIV-free survival of children born to HIV-infected mothers in intent-to-treat analyses. Since early weaning was poorly accepted, we conducted a secondary analysis to investigatewhetherbeneficialeffectsmayhavebeenhidden. Methods:958HIV-infectedwomeninLusaka,Zambia,wererandomizedtoabruptweaningat4months(intervention)orto continuedbreastfeeding(control).Childrenwerefollowedto24monthswithregularHIVPCRtestsandexaminationsto determine HIV infection or death. Detailed behavioral data were collected on when all breastfeeding ended. Most participantswererecruitedbeforeantiretroviraltreatment(ART)becameavailable.Wecomparedoutcomesamongmother- childpairswhoweanedearlierorlaterthanintendedbystudydesignadjustingforpotentialconfounders. Results:Ofinfantsalive,uninfectedandstillbreastfeedingat4monthsintheinterventiongroup,16.1%whoweanedas instructedacquiredHIVordiedby24monthscomparedto16.0%whodidnotcomply(p=0.98).Childrenofwomenwith less severe disease during pregnancy (not eligible for AR