Growth faltering due to breastfeeding cessation in uninfected children born to HIV-infected mothers in Zambia.
BACKGROUND
The effect of breastfeeding on growth in HIV-exposed infants is not well described.


OBJECTIVE
The objective was to evaluate the effect of early breastfeeding cessation on growth.


METHODS
In a trial conducted in Lusaka, Zambia, HIV-infected mothers were randomly assigned to exclusive breastfeeding for 4 mo followed by rapid weaning to replacement foods or exclusive breastfeeding for 6 mo followed by introduction of complementary foods and continued breastfeeding for a duration of the mother's choice. Weight-for-age z score (WAZ), length-for-age z score (LAZ), and weight-for-length z score (WLZ) and the self-reported breastfeeding practices of 593 HIV-uninfected singletons were analyzed. Generalized estimating equations were used to adjust for confounders.


RESULTS
WAZ scores declined precipitously between 4.5 and 15 mo. The decline was slower in the breastfed infants. At 9, 12, and 15 mo, mean WAZs were, respectively, -0.74, -0.92, and -1.06 in infants who were reportedly breastfed and were -1.07, -1.20, and -1.31 in the weaned infants (P = 0.003, 0.007, and 0.02, respectively). No differences were observed past 15 mo. Breastfeeding practice was not associated with LAZ, which declined from -0.98 to -2.24 from 1 to 24 mo. After adjustment for birth weight, maternal viral load, body mass index, education, season, and marital and socioeconomic status, not breastfeeding was associated with a 0.28 decline in WAZ between 4.5 and 15 mo (P < 0.0001). During the rainy season, not breastfeeding was associated with a larger WAZ decline (0.33) than during the dry season (0.22; P for interaction = 0.02).


CONCLUSIONS
Early growth is compromised in uninfected children born to HIV-infected Zambian mothers. Continued breastfeeding partially mitigates this effect through 15 mo. Nutritional interventions to complement breastfeeding after 6 mo are urgently needed. This trial was registered at clinicaltrials.gov as NCT00310726.
Arpadi
Stephen
S
Columbia University Gertrude H Sergievsky Center, College of Physicians and Surgeons and Mailman School of Public Health, New York, NY 10030, USA. sma2@columbia.edu
Fawzy
Ashraf
A
Aldrovandi
Grace M
GM
Kankasa
Chipepo
C
Sinkala
Moses
M
Mwiya
Mwiya
M
Thea
Donald M
DM
Kuhn
Louise
L
D000328:Adult; D000886:Anthropometry; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D001942:Breast Feeding; D015331:Cohort Studies; D005183:Failure to Thrive / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006128:Growth / Q000502:physiology; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000592:standards; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D007231:Infant, Newborn / Q000254:growth & development*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000503:physiopathology*; D012621:Seasons; D013997:Time Factors; D014886:Weaning; D015024:Zambia