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Title: Growth and HIV-free survival of HIV-exposed infants in Malawi: A randomized trial of two complementary feeding interventions in the context of maternal antiretroviral therapy

Author
item THAKWALAKWA, CHRISSIE - University Of Malawi
item PHIRI, AJIB - University Of Malawi
item ROLLINS, NIGEL - World Health Organization (WHO) - Switzerland
item HEIKENS, GEERT - University Of Malawi
item BARNELL, ERICA - Washington University School Of Medicine
item MANARY, MARK - Children'S Nutrition Research Center (CNRC)

Submitted to: Journal of Acquired Immune Deficiency Syndromes
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/7/2014
Publication Date: 6/1/2014
Citation: Thakwalakwa, C., Phiri, A., Rollins, N., Heikens, G.T., Barnell, E.K., Manary, M. 2014. Growth and HIV-free survival of HIV-exposed infants in Malawi: A randomized trial of two complementary feeding interventions in the context of maternal antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes. 66(2):181-187.

Interpretive Summary: This study evaluated growth and HIV-free survival of breastfed newborns between 6-12 months that were receiving a micronutrient supplement and either milk powder or ready-to-use food (RUF). In rural Malawi, pregnant women were offered antiretroviral therapy and instructed to provide nutrients to newborns through breastfeeding and nutritional supplements for the first year of life. Both milk powder and RUF preserved child development such that at 12 months, no children on either supplement developed moderate malnutrition. Additionally, despite previous programs that discouraged HIV mothers from breastfeeding, all mothers readily adopted this practice. This study provides an acceptable method to prevent HIV transmission from HIV-infected mothers to newborns as well as prevent malnutrition for children up to 18 months of age.

Technical Abstract: The objective of this study was to compare the growth of HIV-exposed children receiving 1 of 2 complementary foods after prevention of mother-to-child HIV transmission through maternal lifelong antiretroviral therapy (ART). In rural Malawi, 280 HIV-infected pregnant women were consecutively identified and offered ART, without consideration of their CD4 counts. Mothers were supported to exclusively breast-feed and children tested for HIV status at 1.5 and 5.5 months of age. From this group, 248 HIV-exposed children were enrolled and randomized to receive micronutrients with either whole milk powder or a ready-to-use complementary food (RUF), until the child reached 12 months of age. Children were followed until 18 months of age. HIV-free survival at 12 months was 90% (95% confidence interval: 87% to 94%). Exclusive breast-feeding for the first 6 months of life was practiced in 97% of the children. At 12 months of age, 89% of the children continued to be breast-fed. At 6 months of age, infants had a weight-for-height z score of 0.7 +/- 1.1 (mean +/- SD) and length-for-age z score of -1.3 +/- 1.2. The decrease in length-for-age z score among children receiving RUF at 12 months of age was greater than that seen in those receiving milk powder (-0.3 +/- 0.8 vs -0.1 +/- 0.7, P = 0.04). Mean weight-for-height z score was >0 at 12 and 18 months of age in both groups. HIV-free survival =90% at 12 months was achieved with maternal ART while either milk powder or RUF as a complementary food preserved child anthropometry. Breast-feeding by mothers receiving ART was acceptable.