ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2018
Contribution of Maternal Antiretroviral Therapy and Breastfeeding to 24-Month Survival in Human Immunodeficiency Virus-Exposed Uninfected Children: An Individual Pooled Analysis of African and Asian Studies.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 40 citations in OpenAlex.
- Review
- Exposure to Human Immunodeficiency Virus Is Associated With Altered Composition of Maternal Microchimeric T Cells in Infants.The Journal of infectious diseases · 2025Article
- Prevalence and associated factors with low birth weight among human immunodeficiency virus exposed infants between 2004 and 2021 in Hubei, China: a retrospective cohort study.BMC public health · 2025Article
- Mortality rates in a cohort of infants attending immunization clinics in Uganda (2017-2019).PloS one · 2025Observational
- Pregnancy Outcomes and All-Cause Mortality After Pregnancy Among US-Born Women With Perinatally Acquired HIV.Journal of acquired immune deficiency syndromes (1999) · 2025Article
- Estimating the impact of alternative programmatic cotrimoxazole strategies on mortality among children born to mothers with HIV: A modelling study.PLoS medicine · 2024Review
- Antiretroviral Therapy and Adverse Pregnancy Outcomes in People Living with HIV.The New England journal of medicine · 2023Review
- Clinical and programmatic outcomes of HIV-exposed infants enrolled in care at geographically diverse clinics, 1997-2021: A cohort study.PLoS medicine · 2022Article
- Growth patterns and clinical outcomes in association with breastfeeding duration in HIV exposed and unexposed infants: a cohort study in KwaZulu Natal, South Africa.BMC pediatrics · 2021Article
- The effects of mother's education on achieving exclusive breastfeeding in Indonesia.BMC public health · 2021Article
- Article
- Preventing mother to child transmission of HIV: lessons learned from China.BMC infectious diseases · 2020Article
- HIV-exposed uninfected infant morbidity and mortality within a nationally representative prospective cohort of mother-infant pairs in Zimbabwe.AIDS (London, England) · 2020Article
- New approach to simplifying and optimising acute malnutrition treatment in children aged 6-59 months: the OptiMA single-arm proof-of-concept trial in Burkina Faso.The British journal of nutrition · 2020Article
- Short-term outcomes of HIV-exposed and HIV-unexposed preterm, very low birthweight neonates: a longitudinal, hospital-based study.Journal of perinatology : official journal of the California Perinatal Association · 2020Article
- Breastfeeding Support Offered at Delivery is Associated with Higher Prevalence of Exclusive Breastfeeding at 6 Weeks Postpartum Among HIV Exposed Infants: A Cross-Sectional Analysis.Maternal and child health journal · 2019Article
- Population-level Mortality Associated with HIV Exposure in HIV-uninfected Infants in Botswana and South Africa: A Model-based Evaluation.Journal of tropical pediatrics · 2019Article
- Article
- Surviving and Thriving-Shifting the Public Health Response to HIV-Exposed Uninfected Children: Report of the 3rd HIV-Exposed Uninfected Child Workshop.Frontiers in pediatrics · 2018Article
Corrections and comments
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Authors and funding
25 authors at 19 institutions in 7 countries.
Funding
Abstract
Background: Human immunodeficiency virus (HIV)-infected pregnant women increasingly receive antiretroviral therapy (ART) to prevent mother-to-child transmission (PMTCT). Studies suggest HIV-exposed uninfected (HEU) children face higher mortality than HIV-unexposed children, but most evidence relates to the pre-ART era, breastfeeding of limited duration, and considerable maternal mortality. Maternal ART and prolonged breastfeeding while on ART may improve survival, although this has not been reliably quantified. Methods: Individual data on 19 219 HEU children from 21 PMTCT trials/cohorts undertaken from 1995 to 2015 in Africa and Asia were pooled to estimate the association between 24-month mortality and maternal/infant factors, using random-effects Cox proportional hazards models. Adjusted attributable fractions of risks computed using the predict function in the R package "frailtypack" were used to estimate the relative contribution of risk factors to overall mortality. Results: Cumulative incidence of death was 5.5% (95% confidence interval, 5.1-5.9) by age 24 months. Low birth weight (LBW <2500 g, adjusted hazard ratio (aHR, 2.9), no breastfeeding (aHR, 2.5), and maternal death (aHR, 11.1) were significantly associated with increased mortality. Maternal ART (aHR, 0.5) was significantly associated with lower mortality. At the population level, LBW accounted for 16.2% of 24-month mortality, never breastfeeding for 10.8%, mother not receiving ART for 45.6%, and maternal death for 4.3%; combined, these factors explained 63.6% of deaths by age 24 months. Conclusions: Survival of HEU children could be substantially improved if public health practices provided all HIV-infected mothers with ART and supported optimal infant feeding and care for LBW neonates.
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Registered trials
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