PubMed · 9551023
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
F Dubois-Arber. 1998. HIV testing.. https://doi.org/10.2105/ajph.88.4.683-a
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
CONTEXT: Transmission of human immunodeficiency virus type 1 (HIV-1) is known to occur through breastfeeding, but the magnitude of risk has not been precisely defined. Whether breast milk HIV-1 transmission risk exceeds the potential risk of formula-associated diarrheal mortality in developing countries is unknown. OBJECTIVES: To determine the frequency of breast milk transmission of HIV-1 and to compare mortality rates and HIV-1-free survival in breastfed and formula-fed infants. DESIGN AND SETTING: Randomized clinical trial conducted from November 1992 to July 1998 in antenatal clinics in Nairobi, Kenya, with a median follow-up period of 24 months. PARTICIPANTS: Of 425 HIV-1-seropositive, antiretroviral-naive pregnant women enrolled, 401 mother-infant pairs were included in the analysis of trial end points. INTERVENTIONS: Mother-infant pairs were randomized to breastfeeding (n = 212) vs formula feeding arms (n = 213). MAIN OUTCOME MEASURES: Infant HIV-1 infection and death during the first 2 years of life, compared between the 2 intervention groups. RESULTS: Compliance with the assigned feeding modality was 96% in the breastfeeding arm and 70% in the formula arm (P<.001). Median duration of breastfeeding was 17 months. Of the 401 infants included in the analysis, 94% were followed up to HIV-1 infection or mortality end points: 83% for the HIV-1 infection end point and 93% to the mortality end point. The cumulative probability of HIV-1 infection at 24 months was 36.7% (95% confidence interval [CI], 29.4%-44.0%) in the breastfeeding arm and 20.5% (95% CI, 14.0%-27.0%) in the formula arm (P = .001). The estimated rate of breast milk transmission was 16.2% (95% CI, 6.5%-25.9%). Forty-four percent of HIV-1 infection in the breastfeeding arm was attributable to breast milk. Most breast milk transmission occurred early, with 75% of the risk difference between the 2 arms occurring by 6 months, although transmission continued throughout the duration of exposure. The 2-year mortality rates in both arms were similar (breastfeeding arm, 24.4% [95% CI, 18.2%-30.7%] vs formula feeding arm, 20.0% [95% CI, 14.4%-25.6%]; P = .30). The rate of HIV-1-free survival at 2 years was significantly lower in the breastfeeding arm than in the formula feeding arm (58.0% vs 70.0%, respectively; P = .02). CONCLUSIONS: The frequency of breast milk transmission of HIV-1 was 16.2% in this randomized clinical trial, and the majority of infections occurred early during breastfeeding. The use of breast milk substitutes prevented 44% of infant infections and was associated with significantly improved HIV-1-free survival.
Explore the source record for details and available documents.
AIDS surveillance data are the main source of information to perform back-calculation of HIV incidence. We propose a method to incorporate additional information gained by linkage with an HIV surveillance system, containing data on the time of first positive HIV test. In this paper we generalize an earlier method that was developed to use HIV testing data available only for AIDS cases. The new method also makes use of cases with an HIV positive test who have not yet developed AIDS, typically a substantial proportion of the HIV-infected population. Furthermore, we use a more realistic model for the HIV testing rate, incorporating dependence on both time since infection and calendar time. The method makes use of an EM algorithm with generalized additive model smoothing, and is applied to data from Veneto, a region of northern Italy. Our results show that HIV incidence in Veneto peaked in the late 1980s, and decreased thereafter. Importantly, the HIV incidence estimates based on joint analysis of HIV and AIDS surveillance data are more efficient than estimates based on AIDS surveillance data alone. Our estimates also show a decreasing trend in the HIV testing rate over time, which leads to the conclusion that the interval between HIV infection and first positive test has lengthened over time. Furthermore, it is found that for infected individuals, the probability of seeking on HIV test is highest soon after infection.