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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3181cda531
Original Studies

The Effect of Human Immunodeficiency Virus and Breastfeeding on the Nutritional Status of African Children

Taha, Taha MB BS, PhD*; Nour, Samah MB ChB, MPH*; Li, Qing PhD*; Kumwenda, Newton PhD*; Kafulafula, George MB BS, FCOG†; Nkhoma, Chiwawa MPH‡; Broadhead, Robin MB BS, FRCP†

Supplemental Author Material
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Abstract

Background: The risk of HIV-1 infection is high among breast-fed children in sub-Saharan Africa. Monitoring the nutritional status can provide useful information to determine the effect of HIV infection and breast-feeding on child growth and development. We longitudinally assessed the nutritional status and determined its association with HIV infection and breast-feeding among Malawian children.

Methods: We analyzed data from 2 clinical trials to prevent mother-to-child transmission of HIV in Malawi. These trials were conducted during 2000–2003 before the current guidelines were implemented to breast-feed exclusively during the first 6 months and wean thereafter. The nutritional status of children was measured up to age 24 months, using z-scores. Age-specific differences in length-for-age (L/A), weight-for-age (W/A), and weight-for-length (W/L) were compared stratifying by gender and HIV infection status. Multivariable models examined the mean change in z-scores controlling for breast-feeding and other factors.

Results: In this analysis, 1589 children were included. Boys had significantly lower L/A scores and became stunted (z-score −<2 standard deviations) earlier than girls. HIV-infected children had significantly lower mean L/A and W/A z-scores than HIV-uninfected children and became stunted and underweight at an earlier age. In multivariable analysis not being breast-fed and being HIV infected were significantly (P < 0.001) associated with decreases in mean L/A, W/A, and W/L z-scores.

Conclusions: This study shows the impact of infant HIV infection on growth and supports the critical importance of breast-feeding. Mother-to-child transmission of HIV programs should endeavor to preserve breast-feeding and find alternative measures to prevent postnatal HIV transmission.

© 2010 Lippincott Williams & Wilkins, Inc.

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