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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effects of early, abrupt weaning on HIV-free survival of children in Zambia
New England Journal of Medicine, Volume 359, No. 2, Year 2008
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Description
BACKGROUND 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. METHODS 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. RESULT In the intervention group, 69.0% of t he 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% sur v ived 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). CONCLUSIONS 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.) Copyright © 2008 Massachusetts Medical Society. All rights reserved.
Authors & Co-Authors
Kuhn, Louise
United States, New York
Mailman School of Public Health
United States, New York
Gertrude H. Sergievsky Center
Aldrovandi, Grace M.
United States, Los Angeles
University of Southern California
Sinkala, Moses M.
Zambia, Lusaka
Lusaka District Health Management Team
Kankasa, Chipepo
Zambia, Lusaka
University Teaching Hospital Lusaka
Semrau, Katherine E.A.
United States, Boston
Boston University
Mwiya, Mwiya
Zambia, Lusaka
University Teaching Hospital Lusaka
Kasonde, Prisca
Zambia, Lusaka
University Teaching Hospital Lusaka
Scott, Nancy A.
United States, Boston
Boston University
Vwalika, Cheswa M.
Zambia, Lusaka
Lusaka District Health Management Team
Walter, Jan
United States, New York
Mailman School of Public Health
Bulterys, Marc G.
United States, Atlanta
Centers for Disease Control and Prevention
Tsai, Wei Yann
United States, New York
Mailman School of Public Health
Thea, Donald M.
United States, Boston
Boston University
Statistics
Citations: 305
Authors: 13
Affiliations: 7
Identifiers
Doi:
10.1056/NEJMoa073788
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Cohort Study
Study Locations
Zambia
Participants Gender
Female