The University of Southampton
University of Southampton Institutional Repository

HIV-free survival at 12 – 24 months in breastfed infants of HIV-infected women on ART: a systematic review

HIV-free survival at 12 – 24 months in breastfed infants of HIV-infected women on ART: a systematic review
HIV-free survival at 12 – 24 months in breastfed infants of HIV-infected women on ART: a systematic review
Objective: To provide estimates of HIV-free survival at 12-24 months in breastfed children by maternal ART (6 months or lifelong) to inform WHO HIV and Infant Feeding guidelines.

Methods: Eighteen studies published 2005-2015 were included in a systematic literature review (1295 papers identified, 156 abstracts screened, 55 full texts); papers were analysed by narrative synthesis and meta-analysis of HIV-free survival by maternal ART regimen in a random effects model. We also grouped studies by feeding modality. Study quality was assessed using a modified Newcastle-Ottawa Scale (NOS) and GRADE.

Results: The pooled estimates for 12-month HIV-free survival were 89.8% (95% confidence interval, CI: 86.5%, 93.2%) for infants of mothers on ART for 6 months postnatally (six studies) and 91.4% (95% CI 87.5%, 95.4%) for infants of mothers on lifelong ART (three studies). 18-month HIV-free survival estimates were 89.0% (95% CI 83.9%, 94.2%) with 6 months ART (five studies) and 96.1% (95% CI 92.8%, 99.0%) with lifelong ART (three studies). 24-month HIV-free survival for infants whose mothers were on ART to 6 months postnatally (two studies) was 89.2% (95% CI 79.9%, 98.5%). Heterogeneity was considerable throughout. In four studies, HIV-free survival in breastfed infants ranged from 87% (95% CI 78%, 92%) to 96% (95% CI 91%, 98%) and in formula-fed infants from 67% (95% CI 35.5%, 87.9%) to 97.6% (95% CI 93.0%, 98.2%).

Conclusion: Our results highlight the importance of breastfeeding for infant survival and of ART in reducing the risk of mother-to-child HIV transmission and support the WHO recommendation to initiate ART for life immediately after HIV diagnosis.
1360-2276
1-18
Chikhungu, Lana Clara
db8d9e7a-183e-49aa-aa84-0ff3f0cbb86d
Bispo, Stephanie
a12791e9-146e-4588-91b3-4ef2d77d7f6d
Rollins, Nigel
79b9cfdb-4a6b-44c1-89d9-dbe948a09167
Siegfried, Nandi
f5f4b7d1-ae36-44ac-a433-1034173d0d27
Newell, Marie-Louise
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Chikhungu, Lana Clara
db8d9e7a-183e-49aa-aa84-0ff3f0cbb86d
Bispo, Stephanie
a12791e9-146e-4588-91b3-4ef2d77d7f6d
Rollins, Nigel
79b9cfdb-4a6b-44c1-89d9-dbe948a09167
Siegfried, Nandi
f5f4b7d1-ae36-44ac-a433-1034173d0d27
Newell, Marie-Louise
c6ff99dd-c23b-4fef-a846-a221fe2522b3

Chikhungu, Lana Clara, Bispo, Stephanie, Rollins, Nigel, Siegfried, Nandi and Newell, Marie-Louise (2016) HIV-free survival at 12 – 24 months in breastfed infants of HIV-infected women on ART: a systematic review. Tropical Medicine & International Health, 1-18. (doi:10.1111/tmi.12710).

Record type: Article

Abstract

Objective: To provide estimates of HIV-free survival at 12-24 months in breastfed children by maternal ART (6 months or lifelong) to inform WHO HIV and Infant Feeding guidelines.

Methods: Eighteen studies published 2005-2015 were included in a systematic literature review (1295 papers identified, 156 abstracts screened, 55 full texts); papers were analysed by narrative synthesis and meta-analysis of HIV-free survival by maternal ART regimen in a random effects model. We also grouped studies by feeding modality. Study quality was assessed using a modified Newcastle-Ottawa Scale (NOS) and GRADE.

Results: The pooled estimates for 12-month HIV-free survival were 89.8% (95% confidence interval, CI: 86.5%, 93.2%) for infants of mothers on ART for 6 months postnatally (six studies) and 91.4% (95% CI 87.5%, 95.4%) for infants of mothers on lifelong ART (three studies). 18-month HIV-free survival estimates were 89.0% (95% CI 83.9%, 94.2%) with 6 months ART (five studies) and 96.1% (95% CI 92.8%, 99.0%) with lifelong ART (three studies). 24-month HIV-free survival for infants whose mothers were on ART to 6 months postnatally (two studies) was 89.2% (95% CI 79.9%, 98.5%). Heterogeneity was considerable throughout. In four studies, HIV-free survival in breastfed infants ranged from 87% (95% CI 78%, 92%) to 96% (95% CI 91%, 98%) and in formula-fed infants from 67% (95% CI 35.5%, 87.9%) to 97.6% (95% CI 93.0%, 98.2%).

Conclusion: Our results highlight the importance of breastfeeding for infant survival and of ART in reducing the risk of mother-to-child HIV transmission and support the WHO recommendation to initiate ART for life immediately after HIV diagnosis.

Text
tmi12710.pdf - Accepted Manuscript
Download (915kB)

More information

Accepted/In Press date: 20 April 2016
e-pub ahead of print date: 27 April 2016
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 393529
URI: http://eprints.soton.ac.uk/id/eprint/393529
ISSN: 1360-2276
PURE UUID: 0f538f33-44a5-46c1-a7f6-352cf53f38b7
ORCID for Marie-Louise Newell: ORCID iD orcid.org/0000-0002-1074-7699

Catalogue record

Date deposited: 28 Apr 2016 12:06
Last modified: 07 Oct 2020 05:46

Export record

Altmetrics

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×