Morbidity and mortality in breastfed and formula-fed infants of HIV-1-infected women: A randomized clinical trial.
BACKGROUND
Breastfeeding among women infected with human immunodeficiency virus type 1 (HIV-1) is associated with substantial risk of HIV-1 transmission, but little is known about the morbidity risks associated with formula feeding in infants of HIV-1-infected women in resource-poor settings.


OBJECTIVE
To compare morbidity, nutritional status, mortality adjusted for HIV-1 status, and cause of death among formula-fed and breastfed infants of HIV-1-infected women.


METHODS
Randomized clinical trial conducted between 1992 and 1998.


METHODS
Four antenatal clinics in Nairobi, Kenya.


METHODS
Of 401 live-born, singleton, or first-born twin infants of randomized HIV-1-seropositive mothers, 371 were included in the analysis of morbidity and mortality.


METHODS
Mothers were randomly assigned either to use formula (n = 186) or to breastfeed (n = 185) their infants.


METHODS
Mortality rates, adjusted for HIV-1 infection status; morbidity; and nutritional status during the first 2 years of life.


RESULTS
Two-year estimated mortality rates among infants were similar in the formula-feeding and breastfeeding arms (20.0% vs 24.4%; hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.5-1.3), even after adjusting for HIV-1 infection status (HR, 1.1; 95% CI, 0.7-1.7). Infection with HIV-1 was associated with a 9.0-fold increased mortality risk (95% CI, 5.3-15.3). The incidence of diarrhea during the 2 years of follow-up was similar in formula and breastfeeding arms (155 vs 149 per 100 person-years, respectively). The incidence of pneumonia was identical in the 2 groups (62 per 100 person-years), and there were no significant differences in incidence of other recorded illnesses. Infants in the breastfeeding arm tended to have better nutritional status, significantly so during the first 6 months of life.


CONCLUSIONS
In this randomized clinical trial, infants assigned to be formula fed or breastfed had similar mortality rates and incidence of diarrhea and pneumonia during the first 2 years of life. However, HIV-1-free survival at 2 years was significantly higher in the formula arm. With appropriate education and access to clean water, formula feeding can be a safe alternative to breastfeeding for infants of HIV-1-infected mothers in a resource-poor setting.
Mbori-Ngacha
D
D
Department of Paediatrics, University of Nairobi, Kenya.
Nduati
R
R
John
G
G
Reilly
M
M
Richardson
B
B
Mwatha
A
A
Ndinya-Achola
J
J
Bwayo
J
J
Kreiss
J
J
D000328:Adult; D001942:Breast Feeding; D002423:Cause of Death; D003906:Developing Countries; D003968:Diarrhea, Infantile / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007225:Infant Food; D007226:Infant Mortality; D007231:Infant, Newborn; D007630:Kenya; D008297:Male; D009017:Morbidity; D009752:Nutritional Status; D011014:Pneumonia / Q000453:epidemiology; D016016:Proportional Hazards Models; D012306:Risk; D016019:Survival Analysis