title: Survival of infants born to HIV-positive mothers, by feeding modality, in Rakai, Uganda.
abstract: BACKGROUND
  Data comparing survival of formula-fed to breast-fed infants in programmatic settings are limited. We compared mortality and HIV-free of breast and formula-fed infants born to HIV-positive mothers in a program in rural, Rakai District Uganda.
  
  
  RESULTS
  One hundred eighty two infants born to HIV-positive mothers were followed at one, six and twelve months postpartum. Mothers were given infant-feeding counseling and allowed to make informed choices as to whether to formula-feed or breast-feed. Eligible mothers and infants received antiretroviral therapy (ART) if indicated. Mothers and their newborns received prophylaxis for prevention of mother-to-child HIV transmission (pMTCT) if they were not receiving ART. Infant HIV infection was detected by PCR (Roche Amplicor 1.5) during the follow-up visits. Kaplan Meier time-to-event methods were used to compare mortality and HIV-free survival. The adjusted hazard ratio (Adjusted HR) of infant HIV-free survival was estimated by Cox regression. Seventy-five infants (41%) were formula-fed while 107 (59%) were breast-fed. Exclusive breast-feeding was practiced by only 25% of breast-feeding women at one month postpartum. The cumulative 12-month probability of infant mortality was 18% (95% CI = 11%-29%) among the formula-fed compared to 3% (95% CI = 1%-9%) among the breast-fed infants (unadjusted hazard ratio (HR) = 6.1(95% CI = 1.7-21.4, P-value < 0.01). There were no statistically significant differentials in HIV-free survival by feeding choice (86% in the formula-fed compared to 96% in breast-fed group (Adjusted RH = 2.8[95%CI = 0.67-11.7, P-value = 0.16]
  
  
  CONCLUSIONS
  Formula-feeding was associated with a higher risk of infant mortality than breastfeeding in this rural population. Our findings suggest that formula-feeding should be discouraged in similar African settings.
authors.affiliation: Department of Clinical Research Studies, Rakai Health Sciences Program, Entebbe, Uganda. jkagayi@rhsp.org
authors.forename: Joseph
authors.initials: J
authors.lastname: Kagaayi
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: Heena
authors.initials: H
authors.lastname: Brahmbhatt
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Nelson
authors.initials: N
authors.lastname: Sewankambo
authors.forename: Veronica
authors.initials: V
authors.lastname: Ddungu
authors.forename: Darix
authors.initials: D
authors.lastname: Ssebagala
authors.forename: Joseph
authors.initials: J
authors.lastname: Sekasanvu
authors.forename: Grace
authors.initials: G
authors.lastname: Kigozi
authors.forename: Fredrick
authors.initials: F
authors.lastname: Makumbi
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
mesh_terms: D000293:Adolescent; D000328:Adult; D001903:Bottle Feeding / Q000706:statistics & numerical data*; D001942:Breast Feeding / Q000453:epidemiology*; D003657:Decision Making; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011247:Pregnancy; D015996:Survival Rate; D014454:Uganda / Q000453:epidemiology