Objective: To compare the growth of HIV-exposed children
receiving 1 of 2 complementary foods after prevention of motherto-child
HIV transmission through maternal lifelong antiretroviral
therapy (ART).
Methods: In rural Malawi, 280 HIV-infected pregnant women
were consecutively identified and offered ART, without consideration
of their CD4 counts. Mothers were supported to exclusively
breast-feed and children tested for HIV status at 1.5 and 5.5 months
of age. From this group, 248 HIV-exposed children were enrolled
and randomized to receive micronutrients with either whole milk
powder or a ready-to-use complementary food (RUF), until the
child reached 12 months of age. Children were followed until 18
months of age.
Results: HIV-free survival at 12 months was 90% (95% confidence
interval: 87% to 94%). Exclusive breast-feeding for the first 6
months of life was practiced in 97% of the children. At 12 months of
age, 89% of the children continued to be breast-fed. At 6 months of
age, infants had a weight-for-height z score of 0.7 6 1.1 (mean 6
SD) and length-for-age z score of 21.3 6 1.2. The decrease in
length-for-age z score among children receiving RUF at 12 months
of age was greater than that seen in those receiving milk powder
(20.3 6 0.8 vs 20.1 6 0.7, P = 0.04). Mean weight-for-height z
score was .0 at 12 and 18 months of age in both groups.
Conclusions: HIV-free survival $90% at 12 months was achieved
with maternal ART while either milk powder or RUF as a complementary
food preserved child anthropometry. Breast-feeding by
mothers receiving ART was acceptable.