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Meta-Analysis
. 2016 Jul;21(7):820-8.
doi: 10.1111/tmi.12710. Epub 2016 May 24.

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

Lana Clara Chikhungu  1 , Stephanie Bispo  2 , Nigel Rollins  3 , Nandi Siegfried  4 , Marie-Louise Newell  5
Affiliations
Meta-Analysis

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

Lana Clara Chikhungu et al. Trop Med Int Health. 2016 Jul.

Abstract
in English, French, Spanish

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 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 sans VIH étaient de 89,8% (intervalle de confiance IC à 95%: 86,5% ‐ 93,2%) pour les nourrissons de mères sous ART durant 6 mois après la naissance (six études) et de 91,4% (IC95%: 87,5% ‐ 95,4%) pour les nourrissons de mères sous ART pour toujours (trois études). Les estimations de la survie à 18 mois sans VIH étaient de 89,0% (IC95%: 83,9% ‐ 94,2%) durant 6 mois sous ART (cinq études) et de 96,1% (IC95%: 92,8% ‐ 99,0%) sous ART pour toujours (trois études). La survie à 24 mois sans VIH pour les nourrissons dont les mères étaient sous ART durant 6 mois après la naissance (deux études) était de 89,2% (IC95%: 79,9% ‐ 98,5%). L'hétérogénéité était considérable tout au long du suivi. Dans quatre études, la survie sans VIH chez les nourrissons allaités au sein variait de 87% (IC95%: 78% ‐ 92%) à 96% (IC95%: 91% ‐ 98%) et chez les nourrissons nourris au lait de formulation, de 67% (IC95%: 35,5% ‐ 87,9%) à 97,6% (IC95%: 93,0% ‐ 98,2%).

Conclusion: Nos résultats soulignent l'importance de l'allaitement maternel pour la survie du nourrisson et de l’ART dans la réduction du risque de transmission du VIH de la mère à l'enfant et soutiennent la recommandation de l’OMS d'initier l’ART pour la vie, immédiatement après le diagnostic du VIH.

Objetivo: Proveer cálculos sobre supervivencia a los 12‐24 meses, libre de VIH, de niños recibiendo lactancia materna de madres en TAR (6 meses o de por vida) que sirvan a las directrices de la OMS sobre VIH y alimentación.

Métodos: Se incluyeron dieciocho estudios publicados entre 2005‐2015, obtenidos mediante una revisión sistemática de la literatura (1295 artículos identificados, 156 resúmenes evaluados, 55 textos completos leídos); los artículos se analizaron mediante una síntesis narrativa y meta‐análisis de supervivencia libre de VIH según el régimen materno de TAR en un modelo de efectos aleatorios. También agrupamos estudios según la modalidad de alimentación. La calidad del estudio se evaluó utilizando una modificación de la Escala Newcastle‐Ottawa (ENO) y GRADE.

Resultados: Los cálculos de supervivencia sin VIH agrupados a los 12 meses eran del 89.8% (intervalo de confianza (IC) 95%: 86.5%, 93.2%) para bebés de madres recibiendo TAR durante 6 meses después del parto (seis estudios) y 91.4% (IC 95% 87.5%, 95.4%) para bebes de madres recibiendo TAR de por vida (tres estudios). Los datos de supervivencia sin VIH a los 18 meses eran del 89.0% (IC 95% 83.9%, 94.2%) con 6 meses de TAR (cinco estudios) y 96.1% (IC 95% 92.8%, 99.0%) con TAR de por vida (tres estudios). La supervivencia sin VIH a los 24‐meses para niños cuyas madres estaban recibiendo dar hasta 6 meses después del parto (dos estudios) era del 89.2% (IC 95% 79.9%, 98.5%). La heterogeneidad era considerable. En cuatro estudios, la supervivencia sin VIH en bebes que recibieron lactancia materna estaba entre el 87% (IC 95% 78%, 92%) y el 96% (IC 95% 91%, 98%) y en bebés alimentados con leche de fórmula entre el 67% (IC 95% 35.5%, 87.9%) y el 97.6% (IC 95% 93.0%, 98.2%).

Conclusión: Nuestros resultados subrayan la importancia de la lactancia para la supervivencia infantil y del TAR en reducir el riesgo de la transmisión madre‐hijo del VIH, y apoyan la recomendación de la OMS de iniciar TAR para toda la vida inmediatamente después del diagnóstico del VIH.

Keywords: ART; HIV-free survival; TAR; antiretroviral treatment; femmes; mujeres; revisión sistemática; revue systématique; supervivencia sin VIH; survie sans VIH; systematic review; women.

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Figures

Figure 1
Figure 1
Flowchart of screening process. Search Terms in PubMed (((Maternal[Title/Abstract] OR mother*[Title/Abstract]) AND (Antiretroviral therapy[Title/Abstract] OR Antiretroviral*[Title/Abstract] OR ART[Title/Abstract] OR ARV[Title/Abstract] OR HAART[Title/Abstract]) AND (HIV free survival[Title/Abstract] OR HIV[Title/Abstract] OR Transmi*[Title/Abstract] OR Death[Title/Abstract] OR Mortality[Title/Abstract]) AND (Breastfeeding[Title/Abstract] OR Postnatal[Title/Abstract] OR Breast*[Title/Abstract])) AND (“2005”[Publication Date] : “2015”[Publication Date])).
Figure 2
Figure 2
Twelve‐month HIV‐free Survival. Group 1: Mothers on ART up to 6 months postnatally. Group 2: Mothers on Lifelong ART. Group 3: Mixture of Lifelong ART and ART up to 6 months postnatally.
Figure 3
Figure 3
Eighteen‐month HIV‐free survival in children whose mothers breastfed and were on ART. Group 1: Mothers on ART up to 6 months postnatally only. Group 2: Mothers on lifelong ART.
Figure 4
Figure 4
Twenty‐four‐month HIV‐free survival in children whose mothers breastfed and were on ART. Group 1: Mothers on ART up to 6 months postnatally. Group 2: Mixture of mothers, some on lifelong ART, others on ART to 6 months postnatally.
Figure 5
Figure 5
HIV‐free survival by feeding modality in four studies. FF, Formula fed, BF, Breastfed. Cournil et al., 2015 excluded mothers in clinical stage 4 or with CD4 <200 cells/mm3. HIV‐free survival excluded endpoints during the first 2 weeks, and was measured at 18 months. Alvarez Uria et al., 2012: HIV free survival was obtained after 8 weeks, and measured at 12 months. Homsy et al., 2010: Mothers received ART when CD4 cell counts ≤250 cells/μl or when with WHO stage III or IV disease. There was no transmission in the study, but four children who died had not been tested. HIV‐free survival was not provided according to feeding modality, but numbers of deaths by feeding were provided. Among 118 children, only nine were formula fed, of whom three died; two received mixed feeding, and both died. Peltier et al., 2009: Mothers with CD4 cell counts ≤350 cells/mm3 remained on ART. HIV free survival was measured at 9 months and endpoints were considered from 24 h.
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References

    1. WHO . Guidelines on HIV and Infant Feeding 2010: Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. Geneva, Switzerland: 2010. (Available from: http://apps.who.int/iris/bitstream/10665/44345/1/9789241599535_eng.pdf) [10 July 2015]. - PubMed
    1. WHO . Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV Infenction: What's new. Geneva, Switzerland: 2015. (Available from: http://www.who.int/hiv/pub/guidelines/arv2013/en/) [10 July 2015].
    1. Wells GA, Shea B, O'Connell D et al The Newcastle‐Ottawa Scale (NOS) for assessing the quality of non randomised studies in meta analysis 2000. (Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp) [5 Sept 2015].
    1. MacPherson P, Houben RM, Glynn JR, Corbett EL, Kranzer K. Pre‐treatment loss to follow‐up in tuberculosis patients in low‐ and lower‐middle‐income countries and high‐burden countries: a systematic review and meta‐analysis. Bull World Health Organ 2014: 92: 126–138. - PMC - PubMed
    1. Guyatt G, Andrew D, Gunn E, Kunz R, Falck‐Ytter Y, Schunemann HJ. GRADE: what is “quality of evidence” and why is it important to clinicians? BMJ 2008: 336: 995–998. - PMC - PubMed

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