Breastfeeding Is Associated with Decreased Risk of Hospitalization among HIV-Exposed, Uninfected Kenyan Infants

Kristjana H. Ásbjörnsdóttir*, Jennifer A. Slyker, Elizabeth Maleche-Obimbo, Dalton Wamalwa, Phelgona Otieno, Christine M. Gichuhi, Grace John-Stewart

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Background: Human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa, with higher morbidity and mortality than HIV-unexposed infants. HEU infants may experience increased morbidity due to breastfeeding avoidance. Objectives: We sought to describe the burden and identify predictors of hospitalization among HEU infants in the first year of life. Methods: Using a retrospective cohort of HIV-infected mothers and their HEU infants in Nairobi, Kenya, we identified infants who were HIV-uninfected at birth and were followed monthly until their last negative HIV test, death, loss to follow-up, or study exit at 1 year of age. Incidence, timing, and reason for hospitalization was assessed overall as well as stratified by feeding method. Predictors of first infectious disease hospitalization were identified using competing risk regression, with HIV acquisition and death as competing risks. Results: Among 388 infants, 113 hospitalizations were reported (35/100 infant-years [the combined years of observation contributed by all infants in the study]; 95% confidence interval [CI], 29-42). Ninety hospitalizations were due to 1 or more infectious diseases (26/100 infant-years; 95% CI, 21-32) - primarily pneumonia (n = 40), gastroenteritis (n = 17), and sepsis (n = 14). Breastfeeding was associated with decreased risk of infectious disease hospitalization (subhazard ratio = 0.39; 95% CI, 0.24-0.64), as was time-updated nutrition status (subhazard ratio = 0.73; 95% CI, 0.61-0.89). Incidence of infectious disease hospitalization among formula-fed infants was 51/100 infant-years (95% CI, 37-70) compared to 19/100 infant-years (95% CI, 14-25) among breastfed infants. Conclusion: Among HEU infants, breastfeeding and nutrition status were associated with reduced hospitalization during the first year of life.

Original languageEnglish
Pages (from-to)NP61-NP66
JournalJournal of Human Lactation
Issue number3
Publication statusPublished - 1 Aug 2016

Bibliographical note

Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The parent study was funded by US National Institute of Child Health and Human Development (grant R01 HD-23412). K.H.A. and G.J.S. were supported in part by NIH K24 HD054314. K.H.A. was supported by NIH Interdisciplinary Training in Cancer Research, T32 CA080416, and by a Trainee Support Grant from the Center for AIDS Research (CFAR) under NIH award number P30AI027757. J.A.S. and K.H.A. were supported in part by a New Investigator Award from CFAR under NIH award number P30AI027757. J.A.S. was supported by NIAID K01AI087369. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2016 The Author(s).

Other keywords

  • Breastfeeding
  • HIV-exposed uninfected
  • Infant morbidity


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