1. Contribution of Maternal Antiretroviral Therapy and Breastfeeding to 24-Month Survival in Human Immunodeficiency Virus-Exposed Uninfected Children: An Individual Pooled Analysis of African and Asian Studies
- Author
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Louise Kuhn, Matthieu Rolland, Hoosen Coovadia, Sophie Le Coeur, Marie-Louise Newell, Tanya Doherty, Shino Arikawa, Glenda Gray, Athena P. Kourtis, Timothy M.M. Farley, Shahin Lockman, Valériane Leroy, Irving F. Hoffman, Robert C. Bollinger, Gonzague Jourdain, Roger L. Shapiro, Pierre Joly, François Dabis, Carina Marquez, Jean H. Humphrey, Laurent Mandelbrot, Renaud Becquet, Nigel Rollins, Max Essex, Carolyne Onyango-Makumbi, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Botswana Harvard AIDS Institute Partnership
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Male ,0301 basic medicine ,Breastfeeding ,HIV Infections ,children, infants ,0302 clinical medicine ,Cumulative incidence ,030212 general & internal medicine ,Articles and Commentaries ,ComputingMilieux_MISCELLANEOUS ,2. Zero hunger ,infants ,Hazard ratio ,3. Good health ,AIDS ,HIV-exposed uninfected ,Breast Feeding ,Infectious Diseases ,Child, Preschool ,Child Mortality ,Female ,Maternal death ,medicine.symptom ,Adult ,Microbiology (medical) ,CHILD_SURVIVAL ,medicine.medical_specialty ,Asia ,Adolescent ,Anti-HIV Agents ,Young Adult ,03 medical and health sciences ,children ,medicine ,DRUGS ,Humans ,MATERNAL_BREASTFEEDING ,Proportional hazards model ,business.industry ,Public health ,Infant ,medicine.disease ,mortality ,030112 virology ,Low birth weight ,Africa ,HIV-1 ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,Breast feeding ,Demography - Abstract
Background Human immunodeficiency virus (HIV)–infected pregnant women increasingly receive antiretroviral therapy (ART) to prevent mother-to-child transmission (PMTCT). Studies suggest HIV-exposed uninfected (HEU) children face higher mortality than HIV-unexposed children, but most evidence relates to the pre-ART era, breastfeeding of limited duration, and considerable maternal mortality. Maternal ART and prolonged breastfeeding while on ART may improve survival, although this has not been reliably quantified. Methods Individual data on 19 219 HEU children from 21 PMTCT trials/cohorts undertaken from 1995 to 2015 in Africa and Asia were pooled to estimate the association between 24-month mortality and maternal/infant factors, using random-effects Cox proportional hazards models. Adjusted attributable fractions of risks computed using the predict function in the R package “frailtypack” were used to estimate the relative contribution of risk factors to overall mortality. Results Cumulative incidence of death was 5.5% (95% confidence interval, 5.1–5.9) by age 24 months. Low birth weight (LBW, Pooled results from 21 studies involving more than 19 000 human immunodeficiency virus–exposed but uninfected children show that an estimated two-thirds of infant deaths are attributable to lack of antiretroviral treatment for mothers, low birth weight, never being breastfed, and mother’s death.
- Published
- 2017
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