title: Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-infected mothers.
abstract: BACKGROUND
  Early weaning has been recommended to reduce postnatal human immunodeficiency virus (HIV) transmission. We evaluated the safety of stopping breast-feeding at different ages for mortality of uninfected children born to HIV-infected mothers.
  
  
  METHODS
  During a trial of early weaning, 958 HIV-infected mothers and their infants were recruited and followed up from birth to 24 months postpartum in Lusaka, Zambia. One-half of the cohort was randomized to wean abruptly at 4 months, and the other half of the cohort was randomized to continue breast-feeding. We examined associations between uninfected child mortality and actual breast-feeding duration and investigated possible confounding and effect modification.
  
  
  RESULTS
  The mortality rate among 749 uninfected children was 9.4% by 12 months of age and 13.6% by 24 months of age. Weaning during the interval encouraged by the protocol (4-5 months of age) was associated with a 2.03-fold increased risk of mortality (95% confidence interval [CI], 1.13-3.65), weaning at 6-11 months of age was associated with a 3.54-fold increase (95% CI, 1.68-7.46), and weaning at 12-18 months of age was associated with a 4.22-fold increase (95% CI, 1.59-11.24). Significant effect modification was detected, such that risks associated with weaning were stronger among infants born to mothers with higher CD4(+) cell counts (>350 cells/microL).
  
  
  CONCLUSIONS
  Shortening the normal duration of breast-feeding for uninfected children born to HIV-infected mothers living in low-resource settings is associated with significant increases in mortality extending into the second year of life. Intensive nutritional and counseling interventions reduce but do not eliminate this excess mortality.
authors.affiliation: Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Departments of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA. lk24@columbia.edu
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Katherine
authors.initials: K
authors.lastname: Semrau
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.forename: Prisca
authors.initials: P
authors.lastname: Kasonde
authors.forename: Mwiya
authors.initials: M
authors.lastname: Mwiya
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Hu
authors.forename: Wei-Yann
authors.initials: WY
authors.lastname: Tsai
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.forename: Grace M
authors.initials: GM
authors.lastname: Aldrovandi
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009026:Mortality / Q000639:trends*; D009035:Mothers; D016019:Survival Analysis; D014886:Weaning; D015024:Zambia / Q000453:epidemiology