17 results on '"Humphrey, Jean"'
Search Results
2. Human immunodeficiency virus transmission during breastfeeding: knowledge, gaps, and challenges for the future.
- Author
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Piwoz EG, Ross J, and Humphrey J
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- Adult, Female, HIV Infections prevention & control, Health Knowledge, Attitudes, Practice, Humans, Infant, Infant Formula, Infant, Newborn, Male, Risk Factors, Viral Load, Breast Feeding adverse effects, Breast Feeding psychology, HIV, HIV Infections transmission, Infectious Disease Transmission, Vertical prevention & control, Milk, Human virology
- Abstract
A number of risk factors for HIV transmission during breastfeeding have been identified. The experience counseling HIV-infected women on infant feeding options has expanded to consider these risk factors. Programmatic evidence is limited, but the review presented here strongly argues for an end to the polarized debate about whether HIV-infected women should breast or formula feed. In reality, neither alternative is risk-free for HIV-exposed infants, and the balance of risks varies in different settings and over time.
- Published
- 2004
3. Intestinal Damage and Inflammatory Biomarkers in Human Immunodeficiency Virus (HIV)–Exposed and HIV-Infected Zimbabwean Infants
- Author
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Prendergast, Andrew J, Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Mutasa, Kuda, Ntozini, Robert, and Humphrey, Jean H.
- Published
- 2017
4. Independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved complementary feeding on early neurodevelopment among children born to HIV-negative mothers in rural Zimbabwe: Substudy of a cluster-randomized trial
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Gladstone, Melissa J., Chandna, Jaya, Kandawasvika, Gwendoline, Ntozini, Robert, Majo, Florence D., Tavengwa, Naume V., Mbuya, Mduduzi N. N., Mangwadu, Goldberg T., Chigumira, Ancikaria, Chasokela, Cynthia M., Moulton, Lawrence H., Stoltzfus, Rebecca J., Humphrey, Jean H., and Prendergast, Andrew J.
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Pediatric research ,Child development -- Research ,Hygiene -- Health aspects ,Rural water supply -- Health aspects -- Zimbabwe ,Poor children -- Health aspects -- Food and nutrition ,Medical personnel ,Glycosylated hemoglobin ,HIV ,Child care ,Health ,Pregnant women ,Child nutrition ,Grammar ,Poverty ,Nutrition ,Handwashing ,Hemoglobins ,Workers ,Child health ,Children ,Biological sciences - Abstract
Background Globally, nearly 250 million children (43% of all children under 5 years of age) are at risk of compromised neurodevelopment due to poverty, stunting, and lack of stimulation. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved infant and young child feeding (IYCF) on early child development (ECD) among children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Methods and findings SHINE was a cluster-randomized community-based 2x2 factorial trial. A total of 5,280 pregnant women were enrolled from 211 clusters (defined as the catchment area of 1-4 village health workers [VHWs] employed by the Zimbabwean Ministry of Health and Child Care). Clusters were randomly allocated to standard of care, IYCF (20 g of small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counseling), WASH (ventilated improved pit latrine, handwashing stations, chlorine, liquid soap, and play yard), and WASH + IYCF. Primary outcomes were child length-for-age Z-score and hemoglobin concentration at 18 months of age. Children who completed the 18-month visit and turned 2 years (102-112 weeks) between March 1, 2016, and April 30, 2017, were eligible for the ECD substudy. We prespecified that primary inferences would be drawn from findings of children born to HIV-negative mothers; these results are presented in this paper. A total of 1,655 HIV-unexposed children (64% of those eligible) were recruited into the ECD substudy from 206 clusters and evaluated for ECD at 2 years of age using the Malawi Developmental Assessment Tool (MDAT) to assess gross motor, fine motor, language, and social skills; the MacArthur-Bates Communicative Development Inventories (CDI) to assess vocabulary and grammar; the A-not-B test to assess object permanence; and a self-control task. Outcomes were analyzed in the intention-to-treat population. For all ECD outcomes, there was not a statistical interaction between the IYCF and WASH interventions, so we estimated the effects of the interventions by comparing the 2 IYCF groups with the 2 non-IYCF groups and the 2 WASH groups with the 2 non-WASH groups. The mean (95% CI) total MDAT score was modestly higher in the IYCF groups compared to the non-IYCF groups in unadjusted analysis: 1.35 (0.24, 2.46; p = 0.017); this difference did not persist in adjusted analysis: 0.79 (-0.22, 1.68; p = 0.057). There was no evidence of impact of the IYCF intervention on the CDI, A-not-B, or self-control tests. Among children in the WASH groups compared to those in the non-WASH groups, mean scores were not different for the MDAT, A-not-B, or self-control tests; mean CDI score was not different in unadjusted analysis (0.99 [95% CI -1.18, 3.17]) but was higher in children in the WASH groups in adjusted analysis (1.81 [0.01, 3.61]). The main limitation of the study was the specific time window for substudy recruitment, meaning not all children from the main trial were enrolled. Conclusions We found little evidence that the IYCF and WASH interventions implemented in SHINE caused clinically important improvements in child development at 2 years of age. Interventions that directly target neurodevelopment (e.g., early stimulation) or that more comprehensively address the multifactorial nature of neurodevelopment may be required to support healthy development of vulnerable children. Trial registration ClinicalTrials.gov NCT01824940, Author(s): Melissa J. Gladstone 1,*, Jaya Chandna 1,2, Gwendoline Kandawasvika 3, Robert Ntozini 2, Florence D. Majo 2, Naume V. Tavengwa 2, Mduduzi N. N. Mbuya 2,4, Goldberg T. Mangwadu [...]
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- 2019
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5. Head circumferences of children born to HIV-infected and HIV-uninfected mothers in Zimbabwe during the preantiretroviral therapy era
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Evans, Ceri, Chasekwa, Bernard, Ntozini, Robert, Humphrey, Jean H., and Prendergast, Andrew J.
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Male ,Zimbabwe ,Anthropometry ,Infant, Newborn ,HIV ,Infant ,HIV Infections ,Clinical Science: Concise Communication ,Child Development ,children ,Pregnancy ,Child, Preschool ,Africa ,head circumference ,Microcephaly ,Humans ,Female ,Longitudinal Studies ,Pregnancy Complications, Infectious ,Head ,Maternal-Fetal Exchange - Abstract
Objectives: To describe the head growth of children according to maternal and child HIV infection status. Design: Longitudinal analysis of head circumference data from 13 647 children followed from birth in the ZVITAMBO trial, undertaken in Harare, Zimbabwe, between 1997 and 2001, prior to availability of antiretroviral therapy (ART) or cotrimoxazole prophylaxis. Methods: Head circumference was measured at birth, then at regular intervals through 24 months of age. Mean head circumference-for-age Z-scores (HCZ) and prevalence of microcephaly (HCZ
- Published
- 2016
6. Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe
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Chandna, Jaya, Ntozini, Robert, Evans, Ceri, Kandawasvika, Gwendoline, Chasekwa, Bernard, Majo, Florence, Mutasa, Kuda, Tavengwa, Naume, Mutasa, Batsirai, Mbuya, Mdhu, Moulton, Lawrence H, Humphrey, Jean H, Prendergast, Andrew, Gladstone, Melissa, and Team, SHINE Trial
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Male ,Rural Population ,Sanitation ,Psychological intervention ,HIV Infections ,Child Development ,0302 clinical medicine ,Pregnancy ,Hygiene ,Cognitive development ,Medicine ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Infant Nutritional Physiological Phenomena ,Original Research ,media_common ,2. Zero hunger ,lcsh:R5-920 ,Health Policy ,Pit latrine ,3. Good health ,HIV-exposed uninfected ,Child, Preschool ,safe drinking water ,Female ,lcsh:Medicine (General) ,Zimbabwe ,Hand washing ,sanitation ,media_common.quotation_subject ,complementary feeding ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Social skills ,Water Supply ,030225 pediatrics ,Environmental health ,Humans ,lcsh:RC109-216 ,early child development ,hand washing ,business.industry ,Drinking Water ,Public Health, Environmental and Occupational Health ,HIV ,Infant ,Child development ,business - Abstract
IntroductionHIV-exposed uninfected children may be at risk of poor neurodevelopment. We aimed to test the impact of improved infant and young child feeding (IYCF) and improved water, sanitation and hygiene (WASH) on early child development (ECD) outcomes.MethodsSanitation Hygiene Infant Nutrition Efficacy was a cluster randomised 2×2 factorial trial in rural Zimbabwe ClinicalTrials.gov NCT01824940). Pregnant women were eligible if they lived in study clusters allocated to standard-of-care (SOC; 52 clusters); IYCF (20 g small-quantity lipid-based nutrient supplement/day from 6 to 18 months, complementary feeding counselling; 53 clusters); WASH (pit latrine, 2 hand-washing stations, liquid soap, chlorine, play space, hygiene counselling; 53 clusters) or IYCF +WASH (53 clusters). Participants and fieldworkers were not blinded. ECD was assessed at 24 months using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social skills); MacArthur Bates Communication Development Inventories (assessing vocabulary and grammar); A-not-B test (assessing object permanence) and a self-control task. Intention-to-treat analyses were stratified by maternal HIV status.ResultsCompared with SOC, children randomised to combined IYCF +WASH had higher total MDAT scores (mean difference +4.6; 95% CI 1.9 to 7.2) and MacArthur Bates vocabulary scores (+8.5 words; 95% CI 3.7 to 13.3), but there was no evidence of effects from IYCF or WASH alone. There was no evidence that that any intervention impacted object permanence or self-control.ConclusionsCombining IYCF and WASH interventions significantly improved motor, language and cognitive development in HIV-exposed children.Trial registration numberNCT01824940.
- Published
- 2020
7. Mortality, Human Immunodeficiency Virus (HIV) Transmission, and Growth in Children Exposed to HIV in Rural Zimbabwe.
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Evans, Ceri, Chasekwa, Bernard, Ntozini, Robert, Majo, Florence D, Mutasa, Kuda, Tavengwa, Naume, Mutasa, Batsirai, Mbuya, Mduduzi N N, Smith, Laura E, Stoltzfus, Rebecca J, Moulton, Lawrence H, Humphrey, Jean H, Prendergast, Andrew J, and Team, for the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial
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HIV prevention ,HIV infection transmission ,ANTHROPOMETRY ,COMPARATIVE studies ,CONFIDENCE intervals ,GROWTH disorders ,HIV ,HIV infections ,HIV-positive persons ,HUMAN growth ,INFANT mortality ,MEDICAL screening ,MOTHERS ,RURAL conditions ,ANTIRETROVIRAL agents ,VERTICAL transmission (Communicable diseases) ,DESCRIPTIVE statistics ,CHILDREN ,FETUS - Abstract
Background Clinical outcomes of children who are human immunodeficiency virus (HIV)–exposed in sub-Saharan Africa remain uncertain. Methods The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial evaluated improved infant and young child feeding (IYCF) and/or improved water, sanitation, and hygiene in 2 rural Zimbabwean districts with 15% antenatal HIV prevalence and > 80% prevention of mother-to-child transmission (PMTCT) coverage. Children born between February 2013 and December 2015 had longitudinal HIV testing and anthropometry. We compared mortality and growth between children who were HIV-exposed and HIV-unexposed through 18 months. Children receiving IYCF were excluded from growth analyses. Results Fifty-one of 738 (7%) children who were HIV-exposed and 198 of 3989 (5%) children who were HIV-unexposed (CHU) died (hazard ratio, 1.41 [95% confidence interval {CI}, 1.02–1.93]). Twenty-five (3%) children who were HIV-exposed tested HIV positive, 596 (81%) were HIV-exposed uninfected (CHEU), and 117 (16%) had unknown HIV status by 18 months; overall transmission estimates were 4.3%–7.7%. Mean length-for-age z score at 18 months was 0.38 (95% CI,.24–.51) standard deviations lower among CHEU compared to CHU. Among 367 children exposed to HIV in non-IYCF arms, 147 (40%) were alive, HIV-free, and nonstunted at 18 months, compared to 1169 of 1956 (60%) CHU (absolute difference, 20% [95% CI, 15%–26%]). Conclusions In rural Zimbabwe, mortality remains 40% higher among children exposed to HIV, vertical transmission exceeds elimination targets, and half of CHEU are stunted. We propose the composite outcome of "alive, HIV free, and thriving" as the long-term goal of PMTCT programs. Clinical Trials Registration NCT01824940. [ABSTRACT FROM AUTHOR]
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- 2021
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8. Cytomegalovirus Acquisition and Inflammation in Human Immunodeficiency Virus-Exposed Uninfected Zimbabwean Infants.
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Evans, Ceri, Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Mutasa, Kuda, Ntozini, Robert, Humphrey, Jean H., and Prendergast, Andrew J.
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CYTOMEGALOVIRUSES ,HIV ,INFANT disease prevention ,C-reactive protein ,PUBLIC health - Abstract
Cytomegalovirus (CMV) acquisition and inflammation were evaluated in 231 human immunodeficiency virus (HIV)-exposed uninfected (HEU) and 100 HIV-unexposed Zimbabwean infants aged 6 weeks. The HEU and HIV-unexposed infants had a similarly high prevalence of CMV (81.4% vs 74.0%, respectively; P = .14), but HEU infants had higher CMV loads (P = .005) and >2-fold higher C-reactive protein (CRP) concentrations (P < .0001). The CMV-positive HEU infants had higher CRP than the CMV-negative HEU infants; this association disappeared after adjusting for maternal HIV load. Overall, CMV acquisition is high in early life, but HEU infants have higher CMV loads and a proinflammatory milieu, which may be driven partly by maternal HIV viremia. [ABSTRACT FROM AUTHOR]
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- 2017
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9. Stunting Mediates the Association between Small-for-Gestational-Age and Postneonatal Mortality.
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Oddo, Vanessa M., Christian, Parul, Katz, Joanne, Li Liu, Kozuki, Naoko, Black, Robert E., Ntozini, Robert, Humphrey, Jean, and Liu, Li
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STUNTED growth ,GESTATIONAL age ,NEONATAL mortality ,CHILD mortality ,MEDIATION ,PROPORTIONAL hazards models ,HIV infection transmission ,BIRTH size ,BIRTH weight ,GROWTH disorders ,INFANT mortality ,LONGITUDINAL method ,SOCIOECONOMIC factors - Abstract
Background: In sub-Saharan Africa, one-third of all births are small for gestational age (SGA), and 4.4 million children are stunted; both conditions increase the risk of child mortality. SGA has also been shown to increase the risk of stunting.Objective: We tested whether the association between SGA and postneonatal mortality is mediated by stunting.Methods: We used longitudinal data from children aged 6 wk to 24 mo (n = 12,155) enrolled in the ZVITAMBO (Zimbabwe Vitamin A for Mothers and Babies) trial. HIV exposure was defined based on maternal HIV status at baseline. SGA was defined as birthweight <10th percentile of the INTERGROWTH-21st (International Fetal and Newborn Growth Consortium for the 21st Century) standards. We used a standard mediation approach by comparing the attenuation of the risk when the mediator was added to the model. We used Cox proportional hazards models first to regress SGA on postneonatal mortality, controlling for age. Stunting (length-for-age z score <-2) was then included in the model to test mediation.Results: Approximately 20% of children were term SGA, and 23% were stunted before their last follow-up visit. In this cohort, 31% of children were exposed to HIV; the HIV-exposed group represented a pooled group of HIV-infected and HIV-exposed but uninfected children. Postneonatal mortality was significantly higher among children born SGA (HR: 1.5; 95% CI: 1.3, 1.7). This association was attenuated and not statistically significant when stunting was included in the model, suggesting a mediation effect (HR: 1.1; 95% CI: 0.91, 1.3). When stratified by HIV exposure status, we observed a significant attenuation of the risk, suggesting mediation, only among HIV-exposed children (model 1, HR: 1.3; 95% CI: 1.1, 1.6; model 2, HR: 1.1; 95% CI: 0.88, 1.3).Conclusions: This analysis aids in investigating pathways that underlie an observed SGA-mortality relation and may inform survival interventions in undernourished settings. [ABSTRACT FROM AUTHOR]- Published
- 2016
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10. Short Communication: Heightened HIV Antibody Responses in Postpartum Women as Exemplified by Recent Infection Assays: Implications for Incidence Estimates.
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Hargrove, John W., van Schalkwyk, Cari, Humphrey, Jean H., Mutasa, Kuda, Ntozini, Robert, Owen, Sherry Michele, Masciotra, Silvina, Parekh, Bharat S., Duong, Yen T., Dobbs, Trudy, Kilmarx, Peter H., and Gonese, Elizabeth
- Abstract
Laboratory assays that identify recent HIV infections are important for assessing impacts of interventions aimed at reducing HIV incidence. Kinetics of HIV humoral responses can vary with inherent assay properties, and between HIV subtypes, populations, and physiological states. They are important in determining mean duration of recent infection (MDRI) for antibody-based assays for detecting recent HIV infections. We determined MDRIs for multi-subtype peptide representing subtypes B, E and D (BED)-capture enzyme immunoassay, limiting antigen (LAg), and Bio-Rad Avidity Incidence (BRAI) assays for 101 seroconverting postpartum women, recruited in Harare from 1997 to 2000 during the Zimbabwe Vitamin A for Mothers and Babies trial, comparing them against published MDRIs estimated from seroconverting cases in the general population. We also compared MDRIs for women who seroconverted either during the first 9 months, or at later stages, postpartum. At cutoffs ( C) of 0.8 for BED, 1.5 for LAg, and 40% for BRAI, estimated MDRIs for postpartum mothers were 192, 104, and 144 days, 33%, 32%, and 52% lower than published estimates of 287, 152 and 298 days, respectively, for clade C samples from general populations. Point estimates of MDRI values were 7%-19% shorter for women who seroconverted in the first 9 months postpartum than for those seroconverting later. MDRI values for three HIV incidence biomarkers are longer in the general population than among postpartum women, particularly those who recently gave birth, consistent with heightened immunological activation soon after birth. Our results provide a caution that MDRI may vary significantly between subjects in different physiological states. [ABSTRACT FROM AUTHOR]
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- 2017
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11. In utero and intra-partum HIV-1 transmission and acute HIV-1 infection during pregnancy: using the BED capture enzyme-immunoassay as a surrogate marker for acute infection.
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Marinda, Edmore T, Moulton, Lawrence H, Humphrey, Jean H, Hargrove, John W, Ntozini, Robert, Mutasa, Kuda, and Levin, Jonathan
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HIV infection transmission ,PREGNANCY complications ,CD4 antigen ,SEROCONVERSION ,ENZYME-linked immunosorbent assay ,BIOMARKERS ,COMPARATIVE studies - Abstract
Objective: The BED assay was developed to estimate the proportion of recent HIV infections in a population. We used the BED assay as a proxy for acute infection to quantify the associated risk of mother-to-child-transmission (MTCT) during pregnancy and delivery. Design A total of 3773 HIV-1 sero-positive women were tested within 96 h of delivery using the BED assay, and CD4 cell count measurements were taken. Mothers were classified according to their likelihood of having recently seroconverted.Methods: The risk of MTCT in utero and intra-partum was assessed comparing different groups defined by BED and CD4 cell count, adjusting for background factors using multinomial logistic models.Results: Compared with women with BED ≥ 0.8/CD4 ≥ 350 (typical of HIV-1 chronic patients) there was insufficient evidence to conclude that women presenting with BED < 0.8/CD4 ≥ 350 (typical of recent infections) were more likely to transmit in utero [adjusted odds ratio (aOR) = 1.37, 96% confidence interval (CI) 0.90-2.08, P = 0.14], whereas women with BED < 0.8/CD4 200-349 (possibly recently infected patients) had a 2.57 (95% CI 1.39-4.77, P-value < 0.01) odds of transmitting in utero. Women who had BED < 0.8/CD4 < 200 were most likely to transmit in utero (aOR 3.73, 95% CI 1.27-10.96, P = 0.02). BED and CD4 cell count were not predictive of intra-partum infections.Conclusions: These data provide evidence that in utero transmission of HIV might be higher among women who seroconvert during pregnancy. [ABSTRACT FROM AUTHOR]- Published
- 2011
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12. HIV-positive poor women may stop breast-feeding early to protect their infants from HIV infection although available replacement diets are grossly inadequate.
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Lunney, Kevin M., Jenkins, Alison L., Tavengwa, Naume V., Majo, Florence, Chidhanguro, Dzivaidzó, Iliff, Peter, Strickland, G. Thomas, Piwoz, Ellen, Iannotti, Lora, Humphrey, Jean H., and Chidhanguro, Dzivaidzo
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MOTHERS ,BREASTFEEDING ,INFANTS ,INFANT health ,HIV ,HIV-positive women ,HIV prevention ,DIET ,MICRONUTRIENTS - Abstract
Little is known about mothers' perspectives and experiences of early breast-feeding cessation as a strategy to reduce postnatal HIV transmission in rural, resource-constrained settings. We conducted in-depth interviews (IDI) with 15 HIV-positive breast-feeding mothers of infants aged 3-5 mo about their plans for feeding their infants after age 6 mo. We also conducted IDI with 12 HIV-positive mothers who intended to stop breast-feeding after receiving their infant's HIV-PCR negative test result at age 6 mo. Twenty-four-hour dietary recalls were conducted with the same 12 mothers and 16 HIV-negative or status unknown mothers who were breast-feeding their 6- to 9-mo-old infants. Of the 12 mothers who intended to stop breast-feeding, 11 did so by 9 mo. Median energy intake (percent requirement) was 1382 kJ (54%) among weaned infants compared with 2234 kJ (87%) among breast-feeding infants. Median intakes were <67% of the recommended levels for 9 and 7 of the 12 micronutrients assessed for weaned and breast-feeding infants, respectively. Factors facilitating early breast-feeding cessation were mothers' knowledge about HIV transmission, family support, and disclosure of their HIV status; food unavailability was the primary barrier. HIV-positive mothers in resource-constrained settings may be so motivated to protect their child from HIV that they stop breast-feeding early even when they cannot provide an adequate replacement diet. As reflected in the new World Health Organization guidance, HIV-positive mothers should continue breastfeeding their infants beyond 6 mo if replacement feeding is still not acceptable, feasible, affordable, sustainable, and safe. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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13. Effect of maternal and neonatal vitamin A supplementation and other postnatal factors on anemia in Zimbabwean infants: a prospective, randomized study.
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Miller, Melissa F., Stoltzfus, Rebecca J., Iliff, Peter J., Malaba, Lucie C., Mbuya, Nkosinathi V., and Humphrey, Jean H.
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Background: Anemia is prevalent in infants in developing countries. Its etiology is multifactorial and includes vitamin A deficiency. Objective: Our primary aim was to measure the effect of maternal or neonatal vitamin A supplementation (or both) on hemoglobin and anemia in Zimbabwean infants. Our secondary aim was to identify the underlying causes of postnatal anemia. Design: A randomized, placebo-controlled trial was conducted in 14 110 mothers and their infants; 2854 infants were randomly selected for the anemia substudy, of whom 1592 were successfully observed for 8-14 mo and formed the study sample. Infants were randomly assigned within 96 h of delivery to 1 of 4 treatment groups: mothers and infants received vitamin A; mothers received vitamin A and infants received placebo; mothers received placebo and infants received vitamin A; and mothers and infants received placebo. The vitamin A doses were 400 000 and 50 000 IU in the mothers and infants, respectively. Results: Vitamin A supplementation had no effect on hemoglobin or anemia (hemoglobin <105 g/L) in unadjusted or adjusted analyses. Infant HIV infection independently increased anemia risk >6-fold. Additional predictors of anemia in HIV-negative and -positive infants were male sex and lower total body iron at birth. In addition, in HIV-positive infants, the risk of anemia increased with early infection, low maternal CD4
+ lymphocyte count at recruitment, and frequent morbidity. Six-month plasma ferritin concentrations <12 μg/L were a risk factor in HIV-negative but not in HIV-positive infants. Maternal HIV infection alone did not cause anemia. Conclusion: Prevention of infantile anemia should include efforts to increase the birth endowment of iron and prevent HIV infection. [ABSTRACT FROM AUTHOR]- Published
- 2006
14. Effects of a Single Large Dose of Vitamin A, Given during the Postpartum Period to HIV-Positive Women and Their Infants, on Child HIV Infection, HIV-Free Survival, and Mortality.
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Humphrey, Jean H., Iliff, Peter J., Marinda, Edmore T., Mutasa, Kuda, Moulton, Lawrence H., Chidawanyika, Henry, Ward, Brian J., Nathoo, Kusum J., Malaba, Lucie C., Zijenah, Lynn S., Zvandasara, Partson, Ntozini, Robert, Mzengeza, Faith, Mahomva, Agnes I., Ruff, Andrea J., Mbizvo, Michael T., and Zunguza, Clare D.
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HIV infections , *RETINOIDS , *CAROTENES , *HIV , *BLOOD plasma , *POLYMERASE chain reaction - Abstract
Background. Low maternal serum retinol level is a risk factor for mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). Multiple-large-dose vitamin A supplementation of HIV-positive children reduces mortality. The World Health Organization recommends single-large-dose vitamin A supplementation for postpartum women in areas of prevalent vitamin A deficiency, neonatal dosing is under consideration. We investigated the effect that single-large-dose maternal/neonatal vitamin A supplementation has on MTCT, HIV-free survival, and mortality in HIV-exposed infants. Methods. A total of 14,110 mother-infant pairs were enrolled ⩽96 h after delivery, and both mother and infant, mother only, infant only, or neither received vitamin A supplementation in a randomized, placebo-controlled trial with a 2 × 2 factorial design. All but 4 mothers initiated breast-feeding. A total of 4495 infants born to HIV-positive women were included in the present analysis. Results. Neither maternal nor neonatal vitamin A supplementation significantly affected postnatal MTCT or overall mortality between baseline and 24 months. However, the timing of infant HIV infection modified the effect that supplementation had on mortality. Vitamin A supplementation had no effect in infants who were polymerase chain reaction (PCR) negative for HIV at baseline. In infants who were PCR negative at baseline and PCR positive at 6 weeks, neonatal supplementation reduced mortality by 28% (P = .01), but maternal supplementation had no effect. In infants who were PCR negative at 6 weeks, all 3 vitamin A regimens were associated with ∼2-fold higher mortality (P ⩽ .05). Conclusions. Targeted vitamin A supplementation of HIV-positive children prolongs their survival. However, postpartum maternal and neonatal vitamin A supplementation may hasten progression to death in breast-fed children who are PCR negative at 6 weeks. These findings raise concern about universal maternal or neonatal vitamin A supplementation in HIV-endemic areas. [ABSTRACT FROM AUTHOR]
- Published
- 2006
15. Genetic Variants in Nonclassical Major Histocompatibility Complex Class I Human Leukocyte Antigen (HLA) -- E and HLA-G Molecules Are Associated with Susceptibility to Heterosexual Acquisition of HIV-1.
- Author
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Lajoie, Julie, Hargrove, John, Zijenah, Lynn S., Humphrey, Jean H., Ward, Brian J., and Roger, Michel
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HLA histocompatibility antigens ,MOLECULES ,IMMUNE response ,GENETIC research ,HIV ,WOMEN ,DISEASE risk factors ,HETEROSEXUALS - Abstract
Human leukocyte antigen (HLA)-E and HLA-G molecules act as powerful modulators of the innate immune response. The present study shows that the HLA-E
G genetic variant (the HLA-E* 0103 allele) alone is significantly (P = .001) associated with a 4.0-fold decreased risk of human immunodeficiency virus 1 (HIV-1) infection in Zimbabwean women. Furthermore, women carrying the combination of the protective HLA-EG homozygote and HLA-G*0105N heterozygote genotypes had a 12.5-fold decreased risk of HIV-1 infection (P = .03), compared with women carrying neither genotype. These associations remained significant after adjustment was made for other significant sociodemographic risk factors for HIV prevalence in this population. In conclusion, HLA-E and HLA-G polymorphisms can independently and synergistically influence susceptibility to heterosexual acquisition of HIV-1. [ABSTRACT FROM AUTHOR]- Published
- 2006
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16. An Education and Counseling Program for Preventing Breast-Feeding—Associated HIV Transmission in Zimbabwe: Design and Impact on Maternal Knowledge and Behavior.
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Piwoz, Ellen G., Lliff, Peter J., Tavengwa, Naume, Gavin, Lorrie, Marinda, Edmore, Lunney, Kevin, Zunguza, Clare, Nathoo, Kusum J., ZVITAMBO Study Group, and Humphrey, Jean H.
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HIV infections ,BREASTFEEDING ,HIV-positive women ,HEALTH education ,HEALTH counseling ,MOTHERS -- Services for - Abstract
International guidance on HIV and infant feeding has evolved over the last decade. In response to these changes, we designed, implemented, and evaluated an education and counseling program for new mothers in Harare, Zimbabwe. The program was implemented within the ZVITAMBO trial, in which 14,110 mother-baby pairs were enrolled within 96 h of delivery and were followed at 6 wk, 3 mo, and 3-mo intervals. Mothers were tested for HIV at delivery but were not required to learn their test results. Infant feeding patterns were determined using data provided up to 3 mo. Formative research was undertaken to guide the design of the program that included group education, individual counseling, videos, and brochures. The program was introduced over a 2-mo period: 11,362, 1311, and 1437 women were enrolled into the trial before, during, and after this period. Exclusive breast-feeding was recommended for mothers of unknown or negative HIV status, and for HIV-positive mothers who chose to breast-feed. A questionnaire assessing HIV knowledge and exposure to the program was administered to 1996 mothers enrolling after the program was initiated. HIV knowledge improved with increasing exposure to the program. Mothers who enrolled when the program was being fully implemented were 70% more likely to learn their HIV status early (<3 mo) and 8.4 times more likely to exclusively breast-feed than mothers who enrolled before the program began. Formative research aided in the design of a culturally sensitive intervention, The intervention increased relevant knowledge and improved feeding practices among women who primarily did not know their HIV status. [ABSTRACT FROM AUTHOR]
- Published
- 2005
17. Mortality and Morbidity Among Postpartum HIV-Positive and HIV-Negative Women in Zimbabwe: Risk Factors, Causes, and Impact of Single-Dose Postpartum Vitamin A Supplementation.
- Author
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Zvandasara, Partson, Hargrove, John W., Ntozini, Robert, Chidawanyika, Henry, Mutasa, Kuda, Iliff, Peter J., Moulton, Lawrence H., Mzengeza, Faith, Malaba, Lucie C., Ward, Brian J., Nathoo, Kusum I., Zijenah, Lynn S., Mbizvo, Michael, Zunguza, Clare, and Humphrey, Jean H.
- Subjects
- *
MORTALITY , *DISEASES , *VITAMIN A , *HIV-positive women - Abstract
The article focuses on the morbidity and mortality among the postpartum HIV-positive and HIV-negative women in Zimbabwe in relation to vitamin A supplementation. It mentions that the single-dose postpartum supplementation of vitamin A had no effect on the maternal mortality. Moreover, vitamin A status was sufficient in the HIV-negative women while unresponsive to supplementation in the HIV-positive women.
- Published
- 2006
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