title: Growth and HIV-free survival of HIV-exposed infants in Malawi: a randomized trial of two complementary feeding interventions in the context of maternal antiretroviral therapy.
abstract: OBJECTIVE
  To compare the growth of HIV-exposed children receiving 1 of 2 complementary foods after prevention of mother-to-child HIV transmission through maternal lifelong antiretroviral therapy (ART).
  
  
  METHODS
  In rural Malawi, 280 HIV-infected pregnant women were consecutively identified and offered ART, without consideration of their CD4 counts. Mothers were supported to exclusively breast-feed and children tested for HIV status at 1.5 and 5.5 months of age. From this group, 248 HIV-exposed children were enrolled and randomized to receive micronutrients with either whole milk powder or a ready-to-use complementary food (RUF), until the child reached 12 months of age. Children were followed until 18 months of age.
  
  
  RESULTS
  HIV-free survival at 12 months was 90% (95% confidence interval: 87% to 94%). Exclusive breast-feeding for the first 6 months of life was practiced in 97% of the children. At 12 months of age, 89% of the children continued to be breast-fed. At 6 months of age, infants had a weight-for-height z score of 0.7 ± 1.1 (mean ± SD) and length-for-age z score of -1.3 ± 1.2. The decrease in length-for-age z score among children receiving RUF at 12 months of age was greater than that seen in those receiving milk powder (-0.3 ± 0.8 vs -0.1 ± 0.7, P = 0.04). Mean weight-for-height z score was >0 at 12 and 18 months of age in both groups.
  
  
  CONCLUSIONS
  HIV-free survival ≥90% at 12 months was achieved with maternal ART while either milk powder or RUF as a complementary food preserved child anthropometry. Breast-feeding by mothers receiving ART was acceptable.
authors.affiliation: Departments of *Community Health; †Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi; ‡Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland; and §Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110.
authors.forename: Chrissie
authors.initials: C
authors.lastname: Thakwalakwa
authors.forename: Ajib
authors.initials: A
authors.lastname: Phiri
authors.forename: Nigel
authors.initials: N
authors.lastname: Rollins
authors.forename: Geert T
authors.initials: GT
authors.lastname: Heikens
authors.forename: Erica K
authors.initials: EK
authors.lastname: Barnell
authors.forename: Mark
authors.initials: M
authors.lastname: Manary
mesh_terms: D000886:Anthropometry; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D002657:Child Development; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology; D012424:Rural Population; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D018977:Micronutrients