Breastfeeding, HIV status and weights in South African children: a comparison of HIV-exposed and unexposed children.
OBJECTIVE
To examine growth of children by maternal and infant HIV status allowing for infant feeding mode.


METHODS
Women enrolled into a nonrandomized intervention cohort.


METHODS
Children of HIV-infected and uninfected women weighed and assessed for HIV status, monthly: from birth to 9 months; quarterly: 10-24 months. Daily infant feeding practices recorded at weekly intervals. Weight-for-age z-scores of children born to HIV-infected mothers compared with the reference population of children of HIV-uninfected mothers. Changes in z-scores over age were examined by HIV infection status and infant feeding practice using linear mixed effects models.


RESULTS
The 1261 children of HIV-infected mothers grew as well as the reference group of 1061 children of HIV-uninfected mothers, irrespective of feeding mode. z-scores for HIV-infected children were consistently lower than those of HIV-exposed but uninfected children: a difference of 420 g for male children and 405 g for female children at 52 weeks of age. Breastfed HIV-infected infants had consistently higher z-scores for weight, especially during first 6 weeks (difference of 130 g for male children; 110 g for female children). In an adjusted regression analysis, maternal mid-upper arm circumference, CD4 cell count, infant birth weight and HIV status had the biggest impact on infant growth (z-score coefficient: 0.38 for mid-upper arm circumference > or =28.35 vs. <25.7 cm; P < 0.001; -0.32 for CD4 cell count <200 vs. > or =500; P = 0.001; -2.01 for birth weight <2500 vs. > or =2500 g; P < 0.001; -0.20 for infected vs. uninfected children; P < 0.001).


CONCLUSIONS
Optimal early feeding practices ameliorate the effect of being born to an HIV-infected mother and strengthen the recommendation of exclusive breastfeeding for HIV-infected women in terms of long-term child health.
Patel
Deven
D
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal 3935, South Africa.
Bland
Ruth
R
Coovadia
Hoosen
H
Rollins
Nigel
N
Coutsoudis
Anna
A
Newell
Marie-Louise
ML
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015992:Body Mass Index; D001835:Body Weight; D001942:Breast Feeding / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002657:Child Development; D016241:Child of Impaired Parents; D005260:Female; D006128:Growth / Q000502:physiology*; D015658:HIV Infections / Q000453:epidemiology / Q000503:physiopathology* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology; D012737:Sex Factors; D055815:Young Adult