Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-infected mothers.
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.
Kuhn
Louise
L
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
Sinkala
Moses
M
Semrau
Katherine
K
Kankasa
Chipepo
C
Kasonde
Prisca
P
Mwiya
Mwiya
M
Hu
Chih-Chi
CC
Tsai
Wei-Yann
WY
Thea
Donald M
DM
Aldrovandi
Grace M
GM
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