title: Reduced mortality associated with breast-feeding-acquired HIV infection and breast-feeding among HIV-infected children in Zambia.
abstract: OBJECTIVE
  In developing countries, where mother-to-child transmission of HIV through breast-feeding is common, little is known about the impact of postpartum transmission on child survival. This study assessed whether children infected postpartum have longer survival from time of infection versus those infected during gestation or delivery.
  
  
  METHODS
  We used a prospective cohort study to analyze data from 213 HIV-infected children enrolled in a breast-feeding intervention trial in Lusaka, Zambia (2001 to 2004).
  
  
  METHODS
  We compared mortality 1 year after HIV infection in children stratified by age of infection: 0 to 3 days (intrauterine [IU] group), 4 to 40 days (intrapartum/early postpartum [IP/EPP] group), and >40 days (postpartum [PP] group).
  
  
  RESULTS
  A total of 61, 71, and 81 children were infected in the IU, IP/EPP, and PP groups, respectively. Children with intrauterine or intrapartum/early postpartum transmission had higher mortality over the first 12 months after infection than children with postpartum transmission (P = 0.001 and P = 0.006, respectively); no differences were detected between children with intrauterine and intrapartum/early postpartum transmission. Nearly 20% of the IU and IP/EPP groups died by 100 days after infection, whereas nearly 10% of the PP group had died by this time. After adjusting for birth weight, maternal CD4 cell count, breast-feeding, and maternal death, children infected postpartum had one quarter the mortality rate (hazard ratio [HR] = 0.27, 95% confidence interval [CI]: 0.15 to 0.50) of those infected in utero. Stopping breast-feeding increased mortality in infected children (HR = 3.1, 95% CI: 1.8 to 5.3).
  
  
  CONCLUSIONS
  This study demonstrates a survival benefit among children infected postpartum versus children infected during pregnancy or delivery and a benefit to increased breast-feeding duration among infected children. Testing children for HIV early may provide a means to allow for earlier intervention.
authors.affiliation: Center for International Health and Development, Boston University, Boston, MA 02118, USA. mfox@bu.edu
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
authors.forename: Daniel
authors.initials: D
authors.lastname: Brooks
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
authors.forename: Grace
authors.initials: G
authors.lastname: Aldrovandi
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.forename: Mwiya
authors.initials: M
authors.lastname: Mwiya
authors.forename: Robert
authors.initials: R
authors.lastname: Horsburgh
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
mesh_terms: D001942:Breast Feeding / Q000009:adverse effects*; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D015658:HIV Infections / Q000401:mortality / Q000635:transmission*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D015024:Zambia