支持艾滋病毒感染母亲母乳喂养的干预措施：随机对照试验的系统回顾和荟萃分析。

IF 4.3 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Infectious Diseases Pub Date : 2025-08-22 DOI:10.1016/j.ijid.2025.108018

Francesco Vladimiro Segala , Nicola Veronese , Nandita Sugandhi , Giovanni Putoto , Ivy Kasirye , Annalisa Saracino , Francesco Di Gennaro

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引用次数: 0

摘要

背景:。母乳喂养可提高婴儿存活率，特别是在资源匮乏的环境中。尽管在病毒学抑制的艾滋病毒感染母亲中，产后传播的风险低于1%，但纯母乳喂养（EBF）率和艾滋病毒护理的保留率仍然不理想。本综述评估了旨在支持艾滋病毒感染者母乳喂养的非药物干预措施的效果。方法:。我们检索了PubMed、Embase和Cochrane Library，检索了截至2025年1月1日的随机对照试验（rct），以评估设施和社区干预措施。结果包括任何母乳喂养、EBF、母婴滞留和母体病毒抑制。使用Cochrane RoB2工具评估偏倚风险。数据采用随机效应荟萃分析合并，证据确定性采用GRADE评分。该研究遵循PRISMA声明，并在PROSPERO注册，网址：https://www.crd.york.ac.uk/PROSPERO/view/CRD42025636327.Findings。纳入来自南非、乌干达、肯尼亚和印度的8项rct （n= 3715）。卫生保健支持与母体病毒抑制的临界增加相关（RR 1.21, 95% CI 1.00-1.47），相当于每1000名母体病毒抑制增加140名。综合干预措施改善了EBF的吸收（RR 1.38, 95% CI 1.06-1.80），相当于每1000名母亲增加了92名。证据的确定性很低甚至很低。结论:。设施和社区干预措施可能会增加艾滋病患者的EBF。纳入的RCT的主要限制是没有盲法。未发现发表偏倚。需要更多针对具体情况的试验来评估它们对艾滋病毒相关结果的影响。

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Interventions to support breastfeeding among mothers living with HIV: A systematic review and meta-analysis of randomized controlled trials

Background

Breastfeeding improves infant survival, especially in low-resource settings. Although the risk of postnatal transmission is below 1% among virologically suppressed mothers living with HIV, exclusive breastfeeding (EBF) rates and retention in HIV care remain suboptimal. This review evaluated the effect of non-pharmacological interventions aimed at supporting breastfeeding among people living with HIV (PLWH).

Methods

We searched PubMed, Embase, and Cochrane Library up to Jan 1, 2025, for randomized controlled trials (RCTs) assessing facility- and community-based interventions. Outcomes included any breastfeeding, EBF, maternal-infant retention, and maternal viral suppression. Risk of bias was assessed using the Cochrane RoB2 tool. Data were pooled using a random-effects meta-analysis, and evidence certainty was rated using GRADE. The study adhered to PRISMA statements and was registered with PROSPERO, https://www.crd.york.ac.uk/PROSPERO/view/CRD42025636327.

Findings

Eight RCTs (n = 3715) from South Africa, Uganda, Kenya, and India were included. Healthcare support was associated with a borderline increase in maternal viral suppression (RR 1.21, 95% CI 1.00-1.47), corresponding to 140 more per 1,000 mothers. Pooled interventions improved EBF uptake (RR 1.38, 95% CI 1.06-1.80), corresponding to 92 more per 1,000 mothers. Certainty of evidence was low to very low.

Conclusions

Facility- and community-based interventions may increase EBF among PLWH. The main limitation of the included RCT was the absence of blinding. No publication bias was detected. More context-specific trials are needed to assess their impact on HIV-related outcomes.

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来源期刊

International Journal of Infectious Diseases 医学-传染病学

CiteScore

18.90

自引率

2.40%

发文量

1020

审稿时长

30 days

期刊介绍： International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.