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Efecto de la lactancia materna y la leche de fórmula en la transmisión del VIH-1: un ensayo clínico aleatorizado
R Nduati1, G John, D Mbori-Ngacha
1Department of Paediatrics, University of Nairobi, Kenya.
JAMA
|March 7, 2000
Resumen
La lactancia materna transmite el virus de la inmunodeficiencia humana tipo 1 (VIH-1) en el 16,2% de los casos, y la mayoría de las infecciones ocurren temprano. La alimentación con fórmula mejoró significativamente la supervivencia libre de VIH-1 en los bebés.
Área de la Ciencia:
- Enfermedades infecciosas Enfermedades infecciosas.
- La pediatría es la medicina de los niños.
- Salud Pública La salud pública.
Sus antecedentes:
- La transmisión del virus de la inmunodeficiencia humana tipo 1 (VIH-1) a través de la lactancia materna es una preocupación significativa, especialmente en los países en desarrollo.
- El riesgo preciso de transmisión de la leche materna frente a los riesgos asociados con la fórmula sigue sin estar claro.
Objetivo del estudio:
- Para cuantificar la frecuencia de transmisión del VIH-1 a través de la leche materna.
- Para comparar las tasas de mortalidad y la supervivencia libre de VIH-1 entre los bebés alimentados con leche materna y los alimentados con fórmula.
Principales métodos:
- Un ensayo clínico aleatorizado que involucró a 401 parejas madre-bebé seropositivas para el VIH-1 en Nairobi, Kenia.
- Los bebés fueron asignados al azar a la lactancia materna o a la leche de fórmula, con un seguimiento de 24 meses.
- Los resultados primarios incluyeron la infección infantil por VIH-1 y la muerte.
Principales resultados:
- La probabilidad acumulada de infección por VIH-1 a los 24 meses fue del 36,7% en el brazo de lactancia materna frente al 20,5% en el brazo de fórmula (P = .001).
- La transmisión de la leche materna representó un estimado del 16,2% de las infecciones, con el 44% de las infecciones en el grupo de lactancia materna atribuibles a la leche materna.
- La supervivencia libre de VIH-1 a los 2 años fue significativamente menor en el brazo de lactancia materna (58,0%) en comparación con el brazo de fórmula (70,0%) (P = .02).
Conclusiones:
- La transmisión de VIH-1 por la leche materna se produjo en el 16,2% de los bebés, predominantemente a principios del período de lactancia materna.
- El uso de sustitutos de la leche materna redujo significativamente las infecciones por VIH-1 en los bebés y mejoró la supervivencia libre de VIH-1.
- Los hallazgos destacan las compensaciones entre la lactancia materna y la alimentación con fórmula para prevenir la transmisión del VIH-1 en entornos de alta prevalencia.
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