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Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda

Peltier, Cécile Alexandraa; Ndayisaba, Gilles Françoisa; Lepage, Philippeb; van Griensven, Johana; Leroy, Valérianec; Pharm, Christine Omesa; Ndimubanzi, Patrick Cyagaa; Courteille, Oliviera; Arendt, Vicd

doi: 10.1097/QAD.0b013e32832ec20d
Clinical Science

Objective: To assess the 9-month HIV-free survival of children with two strategies to prevent HIV mother-to-child transmission.

Design: Nonrandomized interventional cohort study.

Setting: Four public health centres in Rwanda.

Participants: Between May 2005 and January 2007, all consenting HIV-infected pregnant women were included.

Intervention: Women could choose the mode of feeding for their infant: breastfeeding with maternal HAART for 6 months or formula feeding. All received HAART from 28 weeks of gestation. Nine-month cumulative probabilities of HIV transmission and HIV-free survival were determined using the Kaplan–Meier method and compared using the log-rank test. Determinants were analysed using a Cox model analysis.

Results: Of the 532 first-liveborn infants, 227 (43%) were breastfeeding and 305 (57%) were formula feeding. Overall, seven (1.3%) children were HIV-infected of whom six were infected in utero. Only one child in the breastfeeding group became infected between months 3 and 7, corresponding to a 9-month cumulative risk of postnatal infection of 0.5% [95% confidence interval (CI) 0.1–3.4%; P = 0.24] with breastfeeding. Nine-month cumulative mortality was 3.3% (95% CI 1.6–6.9%) in the breastfeeding arm group and 5.7% (95% CI 3.6–9.2%) for the formula feeding group (P = 0.20). HIV-free survival by 9 months was 95% (95% CI 91–97%) in the breastfeeding group and 94% (95% CI 91–96%) for the formula feeding group (P = 0.66), with no significant difference in the adjusted analysis (adjusted hazard ratio for breastfeeding: 1.2 (95% CI 0.5–2.9%).

Conclusion: Maternal HAART while breastfeeding could be a promising alternative strategy in resource-limited countries.

aINT 108 ESTHER Phase 2 Project /Luxembourg (Lux-Development) in Kigali, Rwanda

bHôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium

cINSERM, Unit 897, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux, France

dDepartment of Infectious Diseases, CHU, Luxembourg, Luxembourg.

Received 3 April, 2009

Accepted 21 May, 2009

Correspondence to Cécile Alexandra Peltier, MD, MMed (Ped), 35 Bd Professor Calmette, 24100 Bergerac, France. E-mail: alexandrapeltier@hotmail.com

© 2009 Lippincott Williams & Wilkins, Inc.