title: Postpartum weight change among HIV-infected mothers by antiretroviral prophylaxis and infant feeding modality in a research setting.
abstract: OBJECTIVE
  To assess the relationship between infant feeding, triple-antiretroviral prophylaxis and weight from 2 weeks (baseline) to 6 months postpartum among HIV-infected mothers in a mother-to-child transmission (MTCT) of HIV-prevention trial in five sub-Saharan African sites.
  
  
  METHODS
  HIV-infected pregnant women with CD4 cell counts of 200-500 cells/μl were counselled to choose breastfeeding to 6 months or replacement feeding from delivery. They were randomized to receive perinatal zidovudine and single-dose nevirapine or triple-antiretroviral MTCT prophylaxis until breastfeeding cessation. Mixed-effect linear models were used to compare maternal weight trajectories over time by infant feeding mode. Antiretroviral prophylaxis and BMI at baseline were examined as potential effect modifiers.
  
  
  RESULTS
  Among 797 mothers, 620 (78%) initiated breastfeeding. Wasting (BMI <18.5) was rare at baseline (2%), whereas overweight/obesity (BMI ≥ 25) was common (40%). In the model including all women, breastfeeding was not associated with weight loss up to 6 months, irrespective of baseline BMI and antiretroviral prophylaxis. Triple-antiretroviral prophylaxis was associated with weight gain among replacement-feeding mothers with baseline BMI at least 25 (+0.54 kg/month; P < 0.0001). In the model including breastfeeding mothers only, triple-antiretroviral prophylaxis was associated with weight gain among mothers with baseline BMI at least 25 who ceased breastfeeding before 3 months postpartum (+0.33 kg/month; P = 0.03).
  
  
  CONCLUSIONS
  The results suggest that breastfeeding up to 6 months postpartum is not detrimental for postpartum weight among well nourished HIV-infected mothers at intermediate-disease stage. In the absence of breastfeeding or after weaning, triple-antiretroviral prophylaxis is associated with weight gain among women with high BMI, even after cessation of prophylaxis.
authors.affiliation: aInstitut de Recherche pour le Développement (IRD), Montpellier, France bWHO, Reproductive Health and Research, Geneva, Switzerland cCentre Muraz, Bobo-Dioulasso, Burkina Faso dInternational Centre for Reproductive Health (ICRH), Mombasa, Kenya eInternational Centre for Reproductive Health, Ghent University, Belgium fCentre for International Health, Burnet Institute, Melbourne, Australia gUniversity of Nairobi, Kenya hAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa iEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland jNVPO/OASH/OS/DHHS, Washington, DC, USA. *The Kesho Bora Study Group members are listed in the acknowledgement section.
authors.forename: Cecile
authors.initials: C
authors.lastname: Cames
authors.forename: Amandine
authors.initials: A
authors.lastname: Cournil
authors.forename: Isabelle
authors.initials: I
authors.lastname: de Vincenzi
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaillard
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.forename: Stanley
authors.initials: S
authors.lastname: Luchters
authors.forename: Ruth
authors.initials: R
authors.lastname: Nduati
authors.forename: Kevindra
authors.initials: K
authors.lastname: Naidu
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bork
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000008:administration & dosage; D007231:Infant, Newborn; D008297:Male; D049590:Postpartum Period; D011247:Pregnancy; D015430:Weight Gain; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents