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Postpartum weight change among HIV-infected mothers by antiretroviral prophylaxis and infant feeding modality in a research setting

Cames, Cecilea; Cournil, Amandinea; de Vincenzi, Isabelleb; Gaillard, Philippeb; Meda, Nicolasc; Luchters, Stanleyd,e,f; Nduati, Ruthg; Naidu, Kevindrah; Newell, Marie-Louiseh; Read, Jennifer S.i,j; Bork, Kirstena; for the Kesho Bora Study Group

doi: 10.1097/01.aids.0000433243.24481.c3
Epidemiology and Social

Objective: To assess the relationship between infant feeding, triple-antiretroviral prophylaxis and weight from 2 weeks (baseline) to 6 months postpartum among HIV-infected mothers in a mother-to-child transmission (MTCT) of HIV-prevention trial in five sub-Saharan African sites.

Methods: HIV-infected pregnant women with CD4+ cell counts of 200–500 cells/μl were counselled to choose breastfeeding to 6 months or replacement feeding from delivery. They were randomized to receive perinatal zidovudine and single-dose nevirapine or triple-antiretroviral MTCT prophylaxis until breastfeeding cessation. Mixed-effect linear models were used to compare maternal weight trajectories over time by infant feeding mode. Antiretroviral prophylaxis and BMI at baseline were examined as potential effect modifiers.

Results: Among 797 mothers, 620 (78%) initiated breastfeeding. Wasting (BMI <18.5) was rare at baseline (2%), whereas overweight/obesity (BMI ≥ 25) was common (40%). In the model including all women, breastfeeding was not associated with weight loss up to 6 months, irrespective of baseline BMI and antiretroviral prophylaxis. Triple-antiretroviral prophylaxis was associated with weight gain among replacement-feeding mothers with baseline BMI at least 25 (+0.54 kg/month; P < 0.0001). In the model including breastfeeding mothers only, triple-antiretroviral prophylaxis was associated with weight gain among mothers with baseline BMI at least 25 who ceased breastfeeding before 3 months postpartum (+0.33 kg/month; P = 0.03).

Conclusion: The results suggest that breastfeeding up to 6 months postpartum is not detrimental for postpartum weight among well nourished HIV-infected mothers at intermediate-disease stage. In the absence of breastfeeding or after weaning, triple-antiretroviral prophylaxis is associated with weight gain among women with high BMI, even after cessation of prophylaxis.

aInstitut de Recherche pour le Développement (IRD), Montpellier, France

bWHO, Reproductive Health and Research, Geneva, Switzerland

cCentre Muraz, Bobo-Dioulasso, Burkina Faso

dInternational Centre for Reproductive Health (ICRH), Mombasa, Kenya

eInternational Centre for Reproductive Health, Ghent University, Belgium

fCentre for International Health, Burnet Institute, Melbourne, Australia

gUniversity of Nairobi, Kenya

hAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa

iEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland

jNVPO/OASH/OS/DHHS, Washington, DC, USA.

*The Kesho Bora Study Group members are listed in the acknowledgement section.

Correspondence to Cecile Cames, IRD/UM1, UMI233, CRCF, BP 1386, CP 18524 Dakar, Senegal.Tel: +221 77 840 28 28; fax: +221 33 864 78 53; e-mail: cecile.cames@ird.fr

Received 22 February, 2013

Revised 22 June, 2013

Accepted 9 July, 2013

© 2014 Lippincott Williams & Wilkins, Inc.