Breastfeeding Among Women Living With HIV in the Era of Lifelong ART: An Observational Multicountry Study in Eastern and Southern Africa.

Autor:	Taha TE; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Bandala-Jacques A; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Yende-Zuma N; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.; SAMRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa., Violari A; Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa., Stranix-Chibanda L; University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe., Atuhaire P; Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda., Hanley S; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Umlazi Clinical Research Site, University of Kwazulu-Natal, Durban, South Africa.; University of Kwazulu-Natal, Department of Family Medicine, Durban, South Africa., Gadama L; Johns Hopkins Research Project, Kamuzu University of Health Sciences, Blantyre, Malawi., Chinula L; University of North Carolina Project-Malawi, Lilongwe, Malawi.; Department of Obstetrics and Gynecology, University of North Carolina, Chapel-Hill, NC., Dadabhai S; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Aizire J; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Brummel SS; Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston MA; and., Fowler MG; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2024 Jan 01; Vol. 95 (1), pp. 10-17.
DOI:	10.1097/QAI.0000000000003306
Abstrakt:	Background: Lifelong antiretroviral treatment (ART) use is recommended for pregnant and breastfeeding (BF) women living with HIV (WLWH) to prevent perinatal HIV transmission and improve maternal health. We address 2 objectives in this analysis: (1) determine timing and factors associated with BF cessation and (2) assess the impact of BF on health of WLWH on ART. Setting: This multicountry study included 8 sites in Uganda, Malawi, Zimbabwe, and South Africa. Methods: This was a prospective study of WLWH on lifelong ART. These women initially participated from 2011 to 2016 in a randomized clinical trial (PROMISE) to prevent perinatal HIV transmission and subsequently reenrolled in an observational study (PROMOTE, 2016-2021) to assess ART adherence, safety, and impact. Results: The PROMOTE cohort included 1987 women on ART. Of them, 752 breastfed and were included in analyses of objective 1; all women were included in analyses of objective 2. The median time to BF cessation varied by country (11.2-19.7 months). Country of residence, age, and health status of women were significantly associated with time to BF cessation (compared with Zimbabwe: Malawi, adjusted hazard ratio [aHR] 0.50, 95% confidence interval [95% CI]: 0.40 to 0.62, P < 0.001; South Africa, aHR 1.49, 95% CI: 1.11 to 2.00, P = 0.008; and Uganda, aHR 1.77, 95% CI: 1.37 to 2.29, P < 0.001). Women who breastfed had lower risk of being "unwell" compared with women who never breastfed (adjusted rate ratio 0.87, 95% CI: 0.81 to 0.95 P = 0.030). Conclusion: Women on lifelong ART should be encouraged to continue BF with no concern for their health. Time to BF cessation should be monitored for proper counseling in each country. Competing Interests: The authors have no funding or conflicts of interest to disclose. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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