Publications & Reports

Postpartum weight change among HIV-infected mothers by antiretroviral prophylaxis and infant feeding modality in a research setting.

Cames C, Cournil A, de Vincenzi I, Gaillard P, Meda N, Luchters S, Nduati R, Naidu K, Newell ML, Read JS, Bork K; Kesho Bora Study Group.
aInstitut de Recherche pour le Developpement (IRD), Montpellier, France bWHO, Reproductive Health and Research, Geneva, Switzerland cCentre Muraz, Bobo-Dioulasso, Burkina Faso dInternational Centre for Reproductive Health (ICRH), Mombasa, Kenya eInternati

Abstract

OBJECTIVE: To assess the relationship between infant feeding, triple-antiretroviral prophylaxis and weight from 2 weeks (baseline) to 6 months postpartum among HIV-infected mothers in a mother-to-child transmission (MTCT) of HIV-prevention trial in five sub-Saharan African sites. METHODS: HIV-infected pregnant women with CD4 cell counts of 200-500 cells/mul were counselled to choose breastfeeding to 6 months or replacement feeding from delivery. They were randomized to receive perinatal zidovudine and single-dose nevirapine or triple-antiretroviral MTCT prophylaxis until breastfeeding cessation. Mixed-effect linear models were used to compare maternal weight trajectories over time by infant feeding mode. Antiretroviral prophylaxis and BMI at baseline were examined as potential effect modifiers. RESULTS: Among 797 mothers, 620 (78%) initiated breastfeeding. Wasting (BMI <18.5) was rare at baseline (2%), whereas overweight/obesity (BMI >/= 25) was common (40%). In the model including all women, breastfeeding was not associated with weight loss up to 6 months, irrespective of baseline BMI and antiretroviral prophylaxis. Triple-antiretroviral prophylaxis was associated with weight gain among replacement-feeding mothers with baseline BMI at least 25 (+0.54 kg/month; P < 0.0001). In the model including breastfeeding mothers only, triple-antiretroviral prophylaxis was associated with weight gain among mothers with baseline BMI at least 25 who ceased breastfeeding before 3 months postpartum (+0.33 kg/month; P = 0.03). CONCLUSION: The results suggest that breastfeeding up to 6 months postpartum is not detrimental for postpartum weight among well nourished HIV-infected mothers at intermediate-disease stage. In the absence of breastfeeding or after weaning, triple-antiretroviral prophylaxis is associated with weight gain among women with high BMI, even after cessation of prophylaxis.

Full text of this article is available at the publisher’s web site at:

http://journals.lww.com/aidsonline/pages/articleviewer.aspx?year=2014&issue=01020&article=00010&type=abstract

Publication

  • Journal: AIDS
  • Published: 02/01/2014
  • Volume: 28
  • Issue: 1
  • Pagination: 85-94