{"id":2621,"date":"2007-05-04T11:53:47","date_gmt":"2007-05-04T10:53:47","guid":{"rendered":"http:\/\/moomango.co.uk\/htb\/?p=2621"},"modified":"2013-09-20T16:43:41","modified_gmt":"2013-09-20T16:43:41","slug":"no-benefit-of-early-cessation-of-breastfeeding-in-the-zambia-exclusive-breastfeeding-study-zebs","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/2621","title":{"rendered":"No benefit of early cessation of breastfeeding in the Zambia Exclusive Breastfeeding Study (ZEBS)"},"content":{"rendered":"

Polly Clayden, HIV I-Base<\/strong><\/p>\n

Discussion around formula feeding and breastfeeding had a high profile at this conference. Several studies looked at the risk benefits of feeding modes in various African settings.<\/strong><\/p>\n

Many guidelines and programmes recommend that HIV-positive women in resource poor settings who breastfeed, should end earlier than HIV-negative women. This is intended to reduce transmission, while preserving benefits of breastfeeding for the infants.<\/p>\n

In an oral presentation Moses Sinkala presented findings from the Zambia Exclusive Breastfeeding Study (ZEBS) to evaluate whether or not there is a benefit with stopping breastfeeding abruptly at 4 months. [1]<\/p>\n

In this study, 958 HIV-positive women and their infants were recruited, given single-dose nevirapine, and randomised after the infants were born into two groups. Women in group A stopped breastfeeding abruptly at 4 months, and those in group B continued breastfeeding for the duration of the mother\u0092s informed choice. Exclusive breastfeeding (EBF) was promoted in both groups and 80.6% reported EBF at 4 months.<\/p>\n

Transmission rates at 4 months were 10.1% vs 4.0% in non-EBF vs EBF infants (p=0.002). HR for increased transmission was 3.4 (95% CI, 1.7 to 7.2).<\/p>\n

The median CD4 count of mothers across both groups was 329 cells\/mm3 (IQR 207 to 471 cells\/mm3). Mother and infant pairs were followed for 24 months; there was follow up for 85% of participants.<\/p>\n

The investigators found that there was no significant difference in HIV-free survival between the two groups. With regard to uninfected infant survival at 4 months they reported: 17% of 329 infants in group A and 19% of 331 infants in group B had HIV infection or had died by 24 months (p= 0.21).<\/p>\n

For the 153 infants who were HIV-positive by 4 months, there was a significant benefit for continued breastfeeding:\u00a0 mortality by 12 months was 57% in group A compared to 29% in group B (p= 0.01).<\/p>\n

In group A, 65% mothers reported stopping all breastfeeding by 4 months. In group B, the median duration of breastfeeding was 16 months. Among asymptomatic mothers with higher CD4 counts (>350 cells\/mm3), there was a trend towards better infant outcomes with longer breastfeeding (p= 0.06).<\/p>\n

The investigators concluded: \u0093Our results caution against early cessation of breastfeeding for HIV-infected women living in low-resource settings. In our study, stopping breastfeeding at 4 months resulted in less than anticipated reduction of HIV transmission, a benefit that was offset by increased mortality among uninfected infants.\u0094 They noted that for HIV-positive infants in this study, continuing breastfeeding was beneficial.<\/p>\n

Reference:<\/p>\n

    \n
  1. Sinkala M, Kuhn L , Kankasa C et al. No benefit of early cessation of breastfeeding at 4 Months on HIV-free Survival of Infants Born to HIV-infected mothers in Zambia: The Zambia Exclusive Breastfeeding Study. 14th CROI, 25-28 February 2007, Los Angeles. Oral abstract LB 74.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Polly Clayden, HIV I-Base Discussion around formula feeding and breastfeeding had a high profile at this conference. Several studies looked at the risk benefits of feeding modes in various African settings. Many guidelines and programmes recommend that HIV-positive women in …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,35],"tags":[61],"class_list":["post-2621","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-pmtct-and-maternal-health","tag-croi-2007"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/2621","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=2621"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/2621\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=2621"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=2621"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=2621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}