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Title: 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
Authors: Shino Arikawa
Nigel Rollins
Gonzague Jourdain
Jean Humphrey
Athena P. Kourtis
Irving Hoffman
Max Essex
Tim Farley
Hoosen M. Coovadia
Glenda Gray
Louise Kuhn
Roger Shapiro
Valériane Leroy
Robert C. Bollinger
Carolyne Onyango-Makumbi
Shahin Lockman
Carina Marquez
Tanya Doherty
François Dabis
Laurent Mandelbrot
Sophie Le Coeur
Matthieu Rolland
Pierre Joly
Marie Louise Newell
Renaud Becquet
Keywords: Medicine
Issue Date: 17-May-2018
Abstract: © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. 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 <2500 g, adjusted hazard ratio (aHR, 2.9), no breastfeeding (aHR, 2.5), and maternal death (aHR, 11.1) were significantly associated with increased mortality. Maternal ART (aHR, 0.5) was significantly associated with lower mortality. At the population level, LBW accounted for 16.2% of 24-month mortality, never breastfeeding for 10.8%, mother not receiving ART for 45.6%, and maternal death for 4.3%; combined, these factors explained 63.6% of deaths by age 24 months. Conclusions Survival of HEU children could be substantially improved if public health practices provided all HIV-infected mothers with ART and supported optimal infant feeding and care for LBW neonates.
ISSN: 15376591
Appears in Collections:CMUL: Journal Articles

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