Increased morbidity in early childhood among HIV-exposed uninfected children in Uganda is associated with breastfeeding duration

Abstract

Human immunodeficiency virus (HIV)-exposed uninfected children (HEU) have an increased risk of morbidity and mortality compared with HIV-unexposed uninfected children (HUU); however, prior studies have not fully accounted for the role of both breastfeeding and age on this association. In this cohort of HEU and HUU in Uganda, non-breastfeeding HEU, from 6-11 months compared with non-breastfeeding HUU had a higher risk of hospitalizations [relative risk (RR): 10.1, 95% confidence interval (CI): 3.70-27.6], severe febrile illness (RR: 3.84, 95% CI: 2.06-7.17), severe diarrhea (RR: 6.37, 95% CI: 2.32-17.4) and severe malnutrition (RR: 18.4, 95% CI: 4.68-72.0). There were no differences between morbidity outcomes between breastfeeding HEU and HUU children, aged 6-11 months. In the 12-24 month age group, the only difference in morbidity outcomes among non-breast feeding children was an increased risk of severe malnutrition for HEU. These data suggest that the increased risk of morbidity among HEU aged 6-11 years is partially explained by early cessation of breastfeeding.

Keywords: Africa; Breastfeeding; HIV; HIV-exposed; Morbidity; Mortality.

© The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Figures

Fig. 1.

Study flow diagram. PY accrued from 6 to 24 months were included in this analysis. All PY from children with sickle cell disease or those who HIV sero-converted were excluded from the analysis. For children who withdrew, person-time was included up to study withdrawal date.

Fig. 2.

Proportion of children breastfeeding (exclusive and partial) from 6 to 24 months, stratified by HIV-exposure status.