title: Breastfeeding Is Associated with Decreased Risk of Hospitalization among HIV-Exposed, Uninfected Kenyan Infants.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa, with higher morbidity and mortality than HIV-unexposed infants. HEU infants may experience increased morbidity due to breastfeeding avoidance.
  
  
  OBJECTIVE
  We sought to describe the burden and identify predictors of hospitalization among HEU infants in the first year of life.
  
  
  METHODS
  Using a retrospective cohort of HIV-infected mothers and their HEU infants in Nairobi, Kenya, we identified infants who were HIV-uninfected at birth and were followed monthly until their last negative HIV test, death, loss to follow-up, or study exit at 1 year of age. Incidence, timing, and reason for hospitalization was assessed overall as well as stratified by feeding method. Predictors of first infectious disease hospitalization were identified using competing risk regression, with HIV acquisition and death as competing risks.
  
  
  RESULTS
  Among 388 infants, 113 hospitalizations were reported (35/100 infant-years [the combined years of observation contributed by all infants in the study]; 95% confidence interval [CI], 29-42). Ninety hospitalizations were due to 1 or more infectious diseases (26/100 infant-years; 95% CI, 21-32)-primarily pneumonia (n = 40), gastroenteritis (n = 17), and sepsis (n = 14). Breastfeeding was associated with decreased risk of infectious disease hospitalization (subhazard ratio = 0.39; 95% CI, 0.24-0.64), as was time-updated nutrition status (subhazard ratio = 0.73; 95% CI, 0.61-0.89). Incidence of infectious disease hospitalization among formula-fed infants was 51/100 infant-years (95% CI, 37-70) compared to 19/100 infant-years (95% CI, 14-25) among breastfed infants.
  
  
  CONCLUSIONS
  Among HEU infants, breastfeeding and nutrition status were associated with reduced hospitalization during the first year of life.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA kasbjorn@uw.edu.
authors.forename: Kristjana H
authors.initials: KH
authors.lastname: Ásbjörnsdóttir
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Slyker
authors.affiliation: Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maleche-Obimbo
authors.affiliation: Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Dalton
authors.initials: D
authors.lastname: Wamalwa
authors.affiliation: Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Phelgona
authors.initials: P
authors.lastname: Otieno
authors.affiliation: Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Gichuhi
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA Department of Medicine, University of Washington, Seattle, WA, USA Department of Pediatrics, University of Washington, Seattle, WA, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
mesh_terms: D000328:Adult; D001942:Breast Feeding; D003141:Communicable Diseases / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission*; D015438:Health Behavior; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007630:Kenya; D008297:Male; D009752:Nutritional Status; D065840:Protective Factors; D012189:Retrospective Studies
keywords: HIV-exposed uninfected; breastfeeding; infant morbidity