Effects of early, abrupt weaning on HIV-free survival of children in Zambia
Kuhn, L.; Aldrovandi, G.M.; Sinkala, M.; Kankasa, C.; Semrau, K.; Mwiya, M.; Kasonde, P.; Scott, N.; Vwalika, C.; Walter, J.; Bulterys, M.; Tsai, W-Yann.; Thea, D.M.; Abrams, E.; Colton, T.; Fawzi, W.; Kapiga, S.; Chomba, E.; Allen, S.; Luo, C.; Mofenson, L.; Piwoz, E.; Ryan, K.; Simon, J.; Stein, Z.; Stringer, J.; Vermund, S.
New England Journal of Medicine 359(2): 130-141
2008
ISSN/ISBN: 0028-4793 PMID: 18525036 DOI: 10.1056/nejmoa073788Document Number: 201488
In low-resource settings, many programs recommend that women who are infected with the human immunodeficiency virus (HIV) stop breast-feeding early. We conducted a randomized trial to evaluate whether abrupt weaning at 4 months as compared with the standard practice has a net benefit for HIV-free survival of children. We enrolled 958 HIV-infected women and their infants in Lusaka, Zambia. All the women planned to breast-feed exclusively to 4 months; 481 were randomly assigned to a counseling program that encouraged abrupt weaning at 4 months, and 477 to a program that encouraged continued breast-feeding for as long as the women chose. The primary outcome was either HIV infection or death of the child by 24 months. In the intervention group, 69.0% of the mothers stopped breast-feeding at 5 months or earlier; 68.8% of these women reported the completion of weaning in less than 2 days. In the control group, the median duration of breast-feeding was 16 months. In the overall cohort, there was no significant difference between the groups in the rate of HIV-free survival among the children; 68.4% and 64.0% survived to 24 months without HIV infection in the intervention and control groups, respectively (P=0.13). Among infants who were still being breast-fed and were not infected with HIV at 4 months, there was no significant difference between the groups in HIV-free survival at 24 months (83.9% and 80.7% in the intervention and control groups, respectively; P=0.27). Children who were infected with HIV by 4 months had a higher mortality by 24 months if they had been assigned to the intervention group than if they had been assigned to the control group (73.6% vs. 54.8%, P=0.007). Early, abrupt cessation of breast-feeding by HIV-infected women in a low-resource setting, such as Lusaka, Zambia, does not improve the rate of HIV-free survival among children born to HIV-infected mothers and is harmful to HIV-infected infants.(ClinicalTrials.gov number, NCT00310726.)