Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda.
OBJECTIVE
To assess the 9-month HIV-free survival of children with two strategies to prevent HIV mother-to-child transmission.


METHODS
Nonrandomized interventional cohort study.


METHODS
Four public health centres in Rwanda.


METHODS
Between May 2005 and January 2007, all consenting HIV-infected pregnant women were included.


METHODS
Women could choose the mode of feeding for their infant: breastfeeding with maternal HAART for 6 months or formula feeding. All received HAART from 28 weeks of gestation. Nine-month cumulative probabilities of HIV transmission and HIV-free survival were determined using the Kaplan-Meier method and compared using the log-rank test. Determinants were analysed using a Cox model analysis.


RESULTS
Of the 532 first-liveborn infants, 227 (43%) were breastfeeding and 305 (57%) were formula feeding. Overall, seven (1.3%) children were HIV-infected of whom six were infected in utero. Only one child in the breastfeeding group became infected between months 3 and 7, corresponding to a 9-month cumulative risk of postnatal infection of 0.5% [95% confidence interval (CI) 0.1-3.4%; P = 0.24] with breastfeeding. Nine-month cumulative mortality was 3.3% (95% CI 1.6-6.9%) in the breastfeeding arm group and 5.7% (95% CI 3.6-9.2%) for the formula feeding group (P = 0.20). HIV-free survival by 9 months was 95% (95% CI 91-97%) in the breastfeeding group and 94% (95% CI 91-96%) for the formula feeding group (P = 0.66), with no significant difference in the adjusted analysis (adjusted hazard ratio for breastfeeding: 1.2 (95% CI 0.5-2.9%).


CONCLUSIONS
: Maternal HAART while breastfeeding could be a promising alternative strategy in resource-limited countries.
Peltier
Cécile Alexandra
CA
INT 108 ESTHER Phase 2 Project /Luxembourg (Lux-Development) in Kigali, Rwanda. alexandrapeltier@hotmail.com
Ndayisaba
Gilles François
GF
Lepage
Philippe
P
van Griensven
Johan
J
Leroy
Valériane
V
Pharm
Christine Omes
CO
Ndimubanzi
Patrick Cyaga
PC
Courteille
Olivier
O
Arendt
Vic
V
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001942:Breast Feeding; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000008:administration & dosage*; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D056990:Post-Exposure Prophylaxis / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology; D012432:Rwanda / Q000453:epidemiology; D016019:Survival Analysis