BACKGROUND: Little is known about the safety of infant-feeding interventions aimed at reducing breastmilk HIV transmission in Africa. We assessed the two-year morbidity and mortality among early weaned breastfed and formula-fed children born to HIV-infected mothers in Abidjan, Côte d'Ivoire.
METHODS: HIV-infected pregnant women having received a peri-partum antiretroviral prophylaxis were proposed antenatally two infant-feeding interventions: either artificial feeding, or exclusive breastfeeding then early cessation from four months of age. Nutritional counseling and clinical management were provided during two years. Special attention was given to the collection of data on child morbidity potentially linked to inadequate infant feeding practices: diarrhoea, acute respiratory infections or malnutrition. These morbid events were validated by an independent committee blinded to the child feeding practices. The primary outcome was the first occurrence of adverse health outcomes in children, defined as validated morbid
events or severe events (hospitalization or death). Hazards ratio to compare formula-fed vs. breastfed (reference) children in a Cox model were adjusted on potential confounders (paediatric HIV status and other baseline covariates).
RESULTS: Among the 557 born-alive children included, 262 (47%) were breastfed while 295 were formula-fed. Over the two-year follow-up period, 37% of the formula-fed and 34% of the breastfed children remained free from presenting any adverse health outcome (adjusted relative risk: 1.10; 95%CI: 0.87-1.38; p=0.43). The two-year probability of presenting a severe event was the same among formula-fed (14%) and breastfed children (15%), even after adjustment on potential confounders (adjusted relative risk: 1.19; 95% CI: 0.75-1.91, p=0.44). Mortality rates did not differ significantly between these two groups.
CONCLUSION: We found no difference in two-year rates of adverse health outcomes between early weaned breastfed and formulafed children. Given appropriate nutritional counselling and care, access to clean water and supply of breastmilk substitutes, formula-feeding can be a safe intervention to prevent postnatal HIV transmission in urban African settings.