title: Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda.
abstract: 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.
authors.affiliation: INT 108 ESTHER Phase 2 Project /Luxembourg (Lux-Development) in Kigali, Rwanda. alexandrapeltier@hotmail.com
authors.forename: Cécile Alexandra
authors.initials: CA
authors.lastname: Peltier
authors.forename: Gilles François
authors.initials: GF
authors.lastname: Ndayisaba
authors.forename: Philippe
authors.initials: P
authors.lastname: Lepage
authors.forename: Johan
authors.initials: J
authors.lastname: van Griensven
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
authors.forename: Christine Omes
authors.initials: CO
authors.lastname: Pharm
authors.forename: Patrick Cyaga
authors.initials: PC
authors.lastname: Ndimubanzi
authors.forename: Olivier
authors.initials: O
authors.lastname: Courteille
authors.forename: Vic
authors.initials: V
authors.lastname: Arendt
mesh_terms: 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