Mortality among HIV-1-infected women according to children's feeding modality: an individual patient data meta-analysis.
BACKGROUND
Two recent analyses of HIV-1-infected mothers' mortality according to their children's feeding modality have produced conflicting results.


METHODS
An individual patient data meta-analysis was conducted using data regarding HIV-1-infected women from eligible clinical trials. Analyses included Cox proportional hazards regression modeling, with children's feeding modality treated as a time-dependent covariate.


RESULTS
Of 4237 HIV-1-infected women, 162 (3.8%) died within 18 months after delivery. The risk of mortality during the 18-month period after delivery did not differ significantly by children's feeding modality (ever vs. never breast-fed), with or without adjustment for maternal CD4(+) count. Treating children's feeding modality as a time-dependent covariate, the risk of mortality was lower among women still breast-feeding (hazard ratio = 0.05, 95% confidence interval: 0.03, 0.09; P < 0.0001) than among those who had ceased, with similar results observed with adjustment for maternal CD4(+) count.


CONCLUSIONS
HIV-1-infected women with lower CD4(+) counts were less likely to initiate breast-feeding. Mothers' mortality during the 18-month period after delivery did not differ significantly according to children's feeding modality (ever vs. never breast-fed). Of those women who initiated breast-feeding, the lower mortality risk among those still breast-feeding compared with those not breast-feeding likely represents better overall maternal health (with healthier women being able to breast-feed longer).
D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D001903:Bottle Feeding; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D007223:Infant; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors