The health of HIV-exposed children after early weaning

Matern Child Nutr. 2013 Apr;9(2):217-32. doi: 10.1111/j.1740-8709.2011.00369.x. Epub 2011 Nov 20.

Abstract

There are potential health risks associated with the use of early weaning to prevent mother-to-child transmission of human immunodeficiency virus (HIV) in resource-poor settings. Our objective was to examine growth and nutrient inadequacies among a cohort of children weaned early. Children participating in the Breastfeeding Antiretrovirals and Nutrition (BAN) Study in Lilongwe, Malawi, had HIV-infected mothers, were weaned at 6 months and fed LNS until 12 months. 40 HIV-negative, BAN-exited children were compared with 40 HIV-negative, community children matched on age, gender and local health clinic. Nutrient intake was calculated from 24-h dietary recalls collected from BAN-exited children. Anthropometric measurements were collected from BAN-exited and matched community children at 15-16 months, and 2 months later. Longitudinal random effects sex-stratified models were used to evaluate anthropometric differences between the two groups. BAN-exited children consumed adequate energy, protein and carbohydrates but inadequate amounts of fat. The prevalence of inadequate micronutrient intakes were: 46% for vitamin A; 20% for vitamin B6; 69% for folate; 13% for vitamin C; 19% for iron; 23% for zinc. Regarding growth, BAN-exited girls gained weight at a significantly lower rate {0.02 g kg(-1) per day [95% confidence interval (CI): 0.01, 0.03]} than their matched comparison [0.05 g kg(-1) per day (95% CI: 0.03, 0.07)]; BAN girls grew significantly slower [0.73 cm month(-1) (95% CI: 0.40,1.06)] than their matched comparison (1.55 cm month(-1) [95% CI: 0.98, 2.12]). Among this sample of BAN-exited children, early weaning was associated with dietary deficiencies and girls experienced reduced growth velocity. In resource-poor settings, HIV prevention programmes must ensure that breastfeeding stop only once a nutritionally adequate and safe diet without breast milk can be provided.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anti-Retroviral Agents / administration & dosage
  • Ascorbic Acid / administration & dosage
  • Body Weight
  • Breast Feeding / methods
  • Diet*
  • Dietary Fats / administration & dosage
  • Dietary Proteins / administration & dosage
  • Energy Intake
  • Female
  • Folic Acid / administration & dosage
  • Follow-Up Studies
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology*
  • HIV Seronegativity
  • Humans
  • Infant
  • Iron, Dietary / administration & dosage
  • Longitudinal Studies
  • Malawi
  • Male
  • Malnutrition / epidemiology
  • Malnutrition / prevention & control
  • Micronutrients / administration & dosage
  • Nutritional Status
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Seasons
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Vitamin A / administration & dosage
  • Vitamin B 6 / administration & dosage
  • Vitamins / administration & dosage
  • Weaning*
  • Young Adult
  • Zinc / administration & dosage

Substances

  • Anti-Retroviral Agents
  • Dietary Fats
  • Dietary Proteins
  • Iron, Dietary
  • Micronutrients
  • Vitamins
  • Vitamin A
  • Vitamin B 6
  • Folic Acid
  • Zinc
  • Ascorbic Acid