title: The effect of human immunodeficiency virus and breastfeeding on the nutritional status of African children.
abstract: BACKGROUND
  The risk of HIV-1 infection is high among breast-fed children in sub-Saharan Africa. Monitoring the nutritional status can provide useful information to determine the effect of HIV infection and breast-feeding on child growth and development. We longitudinally assessed the nutritional status and determined its association with HIV infection and breast-feeding among Malawian children.
  
  
  METHODS
  We analyzed data from 2 clinical trials to prevent mother-to-child transmission of HIV in Malawi. These trials were conducted during 2000-2003 before the current guidelines were implemented to breast-feed exclusively during the first 6 months and wean thereafter. The nutritional status of children was measured up to age 24 months, using z-scores. Age-specific differences in length-for-age (L/A), weight-for-age (W/A), and weight-for-length (W/L) were compared stratifying by gender and HIV infection status. Multivariable models examined the mean change in z-scores controlling for breast-feeding and other factors.
  
  
  RESULTS
  In this analysis, 1589 children were included. Boys had significantly lower L/A scores and became stunted (z-score -<2 standard deviations) earlier than girls. HIV-infected children had significantly lower mean L/A and W/A z-scores than HIV-uninfected children and became stunted and underweight at an earlier age. In multivariable analysis not being breast-fed and being HIV infected were significantly (P < 0.001) associated with decreases in mean L/A, W/A, and W/L z-scores.
  
  
  CONCLUSIONS
  This study shows the impact of infant HIV infection on growth and supports the critical importance of breast-feeding. Mother-to-child transmission of HIV programs should endeavor to preserve breast-feeding and find alternative measures to prevent postnatal HIV transmission.
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. ttaha@jhsph.edu
authors.forename: Taha
authors.initials: T
authors.lastname: Taha
authors.forename: Samah
authors.initials: S
authors.lastname: Nour
authors.forename: Qing
authors.initials: Q
authors.lastname: Li
authors.forename: Newton
authors.initials: N
authors.lastname: Kumwenda
authors.forename: George
authors.initials: G
authors.lastname: Kafulafula
authors.forename: Chiwawa
authors.initials: C
authors.lastname: Nkhoma
authors.forename: Robin
authors.initials: R
authors.lastname: Broadhead
mesh_terms: D000328:Adult; D000886:Anthropometry; D001942:Breast Feeding; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000378:metabolism* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D010290:Parents; D012959:Socioeconomic Factors