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dc.contributor.authorKuhn, Louiseen_US
dc.contributor.authorAldrovandi, Grace M.en_US
dc.contributor.authorSinkala, Mosesen_US
dc.contributor.authorKankasa, Chipepoen_US
dc.contributor.authorSemrau, Katherineen_US
dc.contributor.authorKasonde, Priscaen_US
dc.contributor.authorMwiya, Mwiyaen_US
dc.contributor.authorTsai, Wei-Yannen_US
dc.contributor.authorThea, Donald M.en_US
dc.date.accessioned2012-01-11T21:43:54Z
dc.date.available2012-01-11T21:43:54Z
dc.date.issued2009-6-26en_US
dc.identifier.citationKuhn, Louise, Grace M. Aldrovandi, Moses Sinkala, Chipepo Kankasa, Katherine Semrau, Prisca Kasonde, Mwiya Mwiya, Wei-Yann Tsai, Donald M. Thea. "Differential Effects of Early Weaning for HIV-Free Survival of Children Born to HIV-Infected Mothers by Severity of Maternal Disease" PLoS ONE 4(6): e6059. (2009)en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://hdl.handle.net/2144/3249
dc.description.abstractBACKGROUND. We previously reported no benefit of early weaning for HIV-free survival of children born to HIV-infected mothers in intent-to-treat analyses. Since early weaning was poorly accepted, we conducted a secondary analysis to investigate whether beneficial effects may have been hidden. METHODS. 958 HIV-infected women in Lusaka, Zambia, were randomized to abrupt weaning at 4 months (intervention) or to continued breastfeeding (control). Children were followed to 24 months with regular HIV PCR tests and examinations to determine HIV infection or death. Detailed behavioral data were collected on when all breastfeeding ended. Most participants were recruited before antiretroviral treatment (ART) became available. We compared outcomes among mother-child pairs who weaned earlier or later than intended by study design adjusting for potential confounders. RESULTS. Of infants alive, uninfected and still breastfeeding at 4 months in the intervention group, 16.1% who weaned as instructed acquired HIV or died by 24 months compared to 16.0% who did not comply (p=0.98). Children of women with less severe disease during pregnancy (not eligible for ART) had worse outcomes if their mothers weaned as instructed (RH=2.60 95% CI: 1.06-6.36) compared to those who continued breastfeeding. Conversely, children of mothers with more severe disease (eligible for ART but did not receive it) who weaned early had better outcomes (p-value interaction=0.002). In the control group, weaning before 15 months was associated with 3.94-fold (95% CI: 1.65-9.39) increase in HIV infection or death among infants of mothers with less severe disease. CONCLUSION. Incomplete adherence did not mask a benefit of early weaning. On the contrary, for women with less severe disease, early weaning was harmful and continued breastfeeding resulted in better outcomes. For women with more advanced disease, ART should be given during pregnancy for maternal health and to reduce transmission, including through breastfeeding. TRIAL REGISTRATION. Clinical trials.gov NCT00310726en_US
dc.description.sponsorshipNational Institute of Child Health and Human Development (NICHD); National Institutes of Health (R01 HD 39611, R01 HD 40777)en_US
dc.language.isoenen_US
dc.publisherPublic Library of Scienceen_US
dc.rightsKuhn et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_US
dc.titleDifferential Effects of Early Weaning for HIV-Free Survival of Children Born to HIV-Infected Mothers by Severity of Maternal Diseaseen_US
dc.typearticleen_US
dc.identifier.doi10.1371/journal.pone.0006059en_US
dc.identifier.pubmedid19557167en_US
dc.identifier.pmcid2698120en_US


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