Survival of infants born to HIV-positive mothers, by feeding modality, in Rakai, Uganda.
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.
Kagaayi
Joseph
J
Department of Clinical Research Studies, Rakai Health Sciences Program, Entebbe, Uganda. jkagayi@rhsp.org
Gray
Ronald H
RH
Brahmbhatt
Heena
H
Kigozi
Godfrey
G
Nalugoda
Fred
F
Wabwire-Mangen
Fred
F
Serwadda
David
D
Sewankambo
Nelson
N
Ddungu
Veronica
V
Ssebagala
Darix
D
Sekasanvu
Joseph
J
Kigozi
Grace
G
Makumbi
Fredrick
F
Kiwanuka
Noah
N
Lutalo
Tom
T
Reynolds
Steven J
SJ
Wawer
Maria J
MJ
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