title: Effects of cessation of breastfeeding in HIV-1-exposed, uninfected children in Malawi.
abstract: BACKGROUND
  We assessed morbidity rates during short intervals that accompanied weaning and cumulative mortality among HIV-exposed, uninfected infants enrolled in the postexposure prophylaxis of infants in Malawi (PEPI-Malawi) trial.
  
  
  METHODS
  Women were counseled to stop breastfeeding (BF) by 6 months in the PEPI-Malawi trial. HIV-uninfected infants were included in this analysis starting at age 6 months. Breastfeeding and morbidity (illness and/or hospital admission and malnutrition [weight-for-age Z-score, ≤2]) were assessed during age intervals of 6-9, 9-12, and 12-15 months. BF was defined as any BF at the start and end of the interval and no breastfeeding (NBF) was defined as NBF at any time during the interval. The association of NBF with morbidity at each mutually exclusive interval was assessed using Poisson regression models controlling for other factors. Cumulative mortality among infants aged 6-15 months with BF and NBF was assessed using an extended Kaplan-Meier method.
  
  
  RESULTS
  At age 6 months, 1761 HIV-uninfected infants were included in the study. The adjusted rate ratios for illnesses and/or hospital admission for NBF, compared with BF, was 1.7 (P < .0001) at 6-9 months, 1.66 (P = .0001) at 9-12 months, and 1.75 (P = .0008) at 12-15 months. The rates of morbidity were consistently higher among NBF infants during each age interval, compared with BF infants. The 15 months cumulative mortality among BF and NBF children was 3.5% and 6.4% (P = .03), respectively.
  
  
  CONCLUSIONS
  Cessation of BF is associated with acute morbidity events and cumulative mortality. Prolonged BF should be encouraged, in addition to close monitoring of infant health and provision of support services.
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. ttaha@jhsph.edu
authors.forename: Taha E
authors.initials: TE
authors.lastname: Taha
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Shu
authors.initials: S
authors.lastname: Chen
authors.forename: Newton I
authors.initials: NI
authors.lastname: Kumwenda
authors.forename: Linda
authors.initials: L
authors.lastname: Mipando
authors.forename: Kondwani
authors.initials: K
authors.lastname: Nkanaunena
authors.forename: Michael C
authors.initials: MC
authors.lastname: Thigpen
authors.forename: Allan
authors.initials: A
authors.lastname: Taylor
authors.forename: Mary Glenn
authors.initials: MG
authors.lastname: Fowler
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Mofenson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008295:Malawi / Q000453:epidemiology; D009017:Morbidity; D019829:Nevirapine / Q000627:therapeutic use; D016012:Poisson Distribution; D056990:Post-Exposure Prophylaxis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D014886:Weaning; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine; D019829:Nevirapine