AEGiS-13IAC: Morbidity and mortality in breastfed and formula fed infants of HIV-1 infected women: results of a randomized clinical trial.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Morbidity and mortality in breastfed and formula fed infants of HIV-1 infected women: results of a randomized clinical trial.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrC494)

Mbori-Ngacha D, Nduati R, John G, Reilly M, Mwatha A, Overbaugh J, Welch M, Ndinya-Achola J, Bwayo J, Kreiss J
D. Mbori-Ngacha, University of Nairobi, Box 19676, Department of Medical Microbiology Annexe, University of Nairobi, Nairobi, Kenya, Tel.: +254 2 722 710, Fax: +254 2 722 762, E-mail: imani@iconnect.co.ke

BACKGROUND: Breastfeeding contributes to 40-50% of perinatal HIV-1 transmission in breastfeeding populations. Use of replacement feeds is an important prevention strategy for transmission, but risks associated with artificial feeds have not been quantified in the context of HIV-1 infection.

METHODS: HIV-1 infected women identified during pregnancy were randomized to breastfeed or formula feed their infants. Infants were followed monthly from birth to 1 year then 3-monthly to 2 years, and information obtained regarding growth, morbidity, mortality and HIV-1 status.

RESULTS: During 2 year follow-up, growth parameters did not differ overall between 197 infants randomized to breastfeed and 204 infants randomized to formula feed (P = 0.2), nor were there significant differences in diarrheal disease (P = 0.6) respiratory infections (P = 0.2) or other infant morbidity. However during the first 3 months of life, infants in the formula arm had an increased risk of diarrhea (RR 2.7, 95%CI 1.6-4.6), dehydration (RR 11.9, 95% CI 1.6-91.8), and upper respiratory infections (RR 1.3, 95% CI 1.1-1.7). Two year mortality did not differ significantly in the breastfeeding and formula feeding arms overall (cumulative mortality 24% vs. 20%, P = 0.2). When stratified by HIV-1 status, there was no difference in 2 year mortality between breastfeeding and formula feeding arms on either HIV-1 infected infants (P = 0.6) or HIV uninfected infants (P = 1.0).

CONCLUSION: In this randomized clinical trial, infants in both study arms had similar growth parameters and morbidity risk over 2 years of follow-up, except for an increased risk of diarrheal disease and upper respiratory infections during the first 3 months of life. There was no significant difference in 2-year mortality between the arms even after stratifying by HIV-1 infection status. These results suggest that formula feeding can be safely used by HIV-1 infected women in Africa if provided with appropriate education and support.

Keywords: AEGIS, HIV-1, Morbidity, Breast Feeding, HIV Infections, Randomized Controlled Trials, Bottle Feeding, Infant Food, Nutritional Support, Africa, Infant, Adult, Human, Female, Pregnancy, mortality, epidemiology, therapy
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WeOrC494