title: Increased morbidity in early childhood among HIV-exposed uninfected children in Uganda is associated with breastfeeding duration.
abstract: Human immunodeficiency virus (HIV)-exposed uninfected children (HEU) have an increased risk of morbidity and mortality compared with HIV-unexposed uninfected children (HUU); however, prior studies have not fully accounted for the role of both breastfeeding and age on this association. In this cohort of HEU and HUU in Uganda, non-breastfeeding HEU, from 6-11 months compared with non-breastfeeding HUU had a higher risk of hospitalizations [relative risk (RR): 10.1, 95% confidence interval (CI): 3.70-27.6], severe febrile illness (RR: 3.84, 95% CI: 2.06-7.17), severe diarrhea (RR: 6.37, 95% CI: 2.32-17.4) and severe malnutrition (RR: 18.4, 95% CI: 4.68-72.0). There were no differences between morbidity outcomes between breastfeeding HEU and HUU children, aged 6-11 months. In the 12-24 month age group, the only difference in morbidity outcomes among non-breast feeding children was an increased risk of severe malnutrition for HEU. These data suggest that the increased risk of morbidity among HEU aged 6-11 years is partially explained by early cessation of breastfeeding.
authors.affiliation: Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA carina.marquez@ucsf.edu.
authors.forename: Carina
authors.initials: C
authors.lastname: Marquez
authors.affiliation: Infectious Diseases Research Collaboration, Kampala, Uganda.
authors.forename: Jaffer
authors.initials: J
authors.lastname: Okiring
authors.affiliation: Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chamie
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, University of California, San Francisco, CA 94143, USA.
authors.forename: Theodore D
authors.initials: TD
authors.lastname: Ruel
authors.affiliation: Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Jane
authors.initials: J
authors.lastname: Achan
authors.affiliation: Infectious Diseases Research Collaboration, Kampala, Uganda.
authors.forename: Abel
authors.initials: A
authors.lastname: Kakuru
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
authors.affiliation: Center for AIDS Prevention, University of California, San Francisco, CA 94105, USA.
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.affiliation: Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA.
authors.forename: Diane V
authors.initials: DV
authors.lastname: Havlir
authors.affiliation: Division of Infectious Diseases, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA.
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey
mesh_terms: D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D008297:Male; D009017:Morbidity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D012424:Rural Population; D012959:Socioeconomic Factors; D014454:Uganda / Q000453:epidemiology; D014886:Weaning
keywords: Africa; Breastfeeding; HIV; HIV-exposed; Morbidity; Mortality