HIV‐free survival at 12–24 months in breastfed infants of HIV‐infected women on antiretroviral treatment

• Published in: Tropical medicine & international health 2016-07, Vol.21 (7), p.820-828
• Main Authors: Chikhungu, Lana Clara, Bispo, Stephanie, Rollins, Nigel, Siegfried, Nandi, Newell, Marie‐Louise
• Format: Article
• Language: English
• Subjects: Anti-HIV Agents - therapeutic use; antiretroviral treatment; Breast Feeding; Breastfeeding & lactation; Child, Preschool; Female; femmes; Guidelines; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - prevention & control; HIV Infections - transmission; HIV‐free survival; Human immunodeficiency virus; Humans; Infant; Infectious Disease Transmission, Vertical - prevention & control; Meta-analysis; mujeres; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Reviews; revisión sistemática; revue systématique; Studies; supervivencia sin VIH; survie sans VIH; Survival Analysis; Systematic Review; TAR; women
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.12710

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 s 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 post‐natally (six studies) and 91.4% (95% CI 87.5%, 95.4%) for infants of mothers on lifelong ART (three studies). Eighteen‐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). Twenty‐four‐month HIV‐free survival for infants whose mothers were on ART to 6 months post‐natally (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. Objectif Fournir des estimations sur la survie sans VIH entre 12 et 24 mois chez les enfants allaités par des mères sous ART (durant 6 mois ou pour toujours), afin d'informer les directives de l’OMS sur le VIH et l'alimentation des nourrissons. Méthodes Dix‐huit études publiées entre 2005 et 2015 ont été incluses dans une analyse systématique de la littérature (1295 articles identifiés, 156 résumés screenés et 55 textes complets); les articles ont été analysés par synthèse narrative et une méta‐analyse de la survie sans VIH sous un régime ART de la mère dans un modèle à effets aléatoires. Nous avons également regroupé les études par mode d'alimentation. La qualité des études a été évaluée à l'aide de l'Echelle de Newcastle‐Ottawa (NOS) et de GRADE. Résultats Les estimations poolées pour de la survie à 12 mois