Table 3.
Selected sensitivity analyses: optimal breastfeeding duration to maximize HIV-free survival among HIV-exposed, uninfected infants at birth
| Maternal CD4/μL, ARV availability | Base case | Lowest MTCT risks | Highest MTCT risks | RR-RF applies until age 6m | RR-RF applies until age 12m | RR-RF applies for 1m after wean | RR-RF applies for 3m after wean | RR-RF applies for 6m after wean | RR-RF applies for 12m after wean | Mixed feeding in first 6m of life |
|---|---|---|---|---|---|---|---|---|---|---|
| Duration of breastfeeding (months) at which 24-month HIV-free survival is maximizeda,b | ||||||||||
|
| ||||||||||
| RR-RF 2.0 | ||||||||||
|
| ||||||||||
| CD4≤350, no ARVs | 3 | 3 | 0 | 3 | 3 | 0 | 0 | 0 | 3 | 0 |
| CD4>350, no ARVs | 6 | 12 | 3 | 6 | 6 | 3 | 3 | 3 | 6 | 6 |
| CD4≤350, maternal ART | 6 | 24 | 3 | 6 | 6 | 0 | 3 | 3 | 3 | 6 |
| CD4>350, infant NVP | 12 | 18 | 6 | 6 | 12 | 3 | 3 | 3 | 6 | 12 |
| CD4>350, maternal ART | 12 | 24 | 3 | 6 | 12 | 3 | 3 | 6 | 12 | 12 |
|
| ||||||||||
| RR-RF 3.0 | ||||||||||
|
| ||||||||||
| CD4≤350, no ARVs | 6 | 12 | 3 | 6 | 6 | 0 | 3 | 3 | 3 | 3 |
| CD4>350, no ARVs | 12 | 24 | 6 | 6 | 12 | 3 | 6 | 6 | 12 | 12 |
| CD4≤350, maternal ART | 12 | 24 | 9 | 6 | 12 | 3 | 3 | 3 | 12 | 12 |
| CD4>350, infant NVP | 18 | 24 | 12 | 6 | 12 | 3 | 6 | 12 | 18 | 18 |
| CD4>350, maternal ART | 18 | 24 | 12 | 6 | 12 | 3 | 6 | 12 | 18 | 18 |
|
| ||||||||||
| RR-RF 4.0 | ||||||||||
|
| ||||||||||
| CD4≤350, no ARVs | 6 | 12 | 3 | 6 | 6 | 0 | 3 | 3 | 6 | 3 |
| CD4>350, no ARVs | 18 | 24 | 12 | 6 | 12 | 3 | 6 | 12 | 18 | 18 |
| CD4≤350, maternal ART | 18 | 24 | 12 | 6 | 12 | 3 | 6 | 12 | 18 | 18 |
| CD4>350, infant NVP | 18 | 24 | 18 | 6 | 12 | 3 | 6 | 12 | 18 | 18 |
| CD4>350, maternal ART | 24 | 24 | 12 | 6 | 12 | 3 | 12 | 24 | 18 | 24 |
|
| ||||||||||
| RR-RF 5.0 | ||||||||||
|
| ||||||||||
| CD4≤350, no ARVs | 6 | 18 | 6 | 6 | 6 | 0 | 3 | 3 | 6 | 6 |
| CD4>350, no ARVs | 18 | 24 | 12 | 6 | 12 | 3 | 6 | 12 | 18 | 18 |
| CD4≤350, maternal ART | 18 | 24 | 18 | 6 | 12 | 3 | 6 | 12 | 18 | 18 |
| CD4>350, infant NVP | 24 | 24 | 18 | 6 | 12 | 3 | 12 | 24 | 24 | 24 |
| CD4>350, maternal ART | 24 | 24 | 18 | 6 | 12 | 6 | 12 | 24 | 24 | 24 |
|
| ||||||||||
| RR-RF 6.0 | ||||||||||
|
| ||||||||||
| CD4≤350, no ARVs | 12 | 18 | 6 | 6 | 12 | 3 | 3 | 3 | 6 | 12 |
| CD4>350, no ARVs | 18 | 24 | 12 | 6 | 12 | 3 | 6 | 12 | 18 | 18 |
| CD4≤350, maternal ART | 24 | 24 | 18 | 6 | 12 | 3 | 12 | 24 | 24 | 24 |
| CD4>350, infant NVP | 24 | 24 | 24 | 6 | 12 | 3 | 12 | 24 | 24 | 24 |
| CD4>350, maternal ART | 24 | 24 | 18 | 6 | 12 | 6 | 12 | 24 | 24 | 24 |
MTCT: mother-to-child HIV transmission; RR-RF: relative risk of mortality among replacement-fed compared to breastfed infants: m: months; ARVs: antiretroviral drugs; ART: 3-drug antiretroviral therapy; NVP: nevirapine.
Changes in policy conclusions from the base case are indicated by shading: dark orange indicates an optimal breastfeeding duration longer than in the base case, light orange indicates an optimal breastfeeding duration shorter than in the base case, and no shading indicates no change from the base case.
Projected HIV-free survival and results of additional sensitivity analyses are in Appendix Tables C-F, or available from the authors upon request. Results for RR-RF of 1.0 are not shown here, as the optimal breastfeeding duration remained 0 months in all sensitivity analyses.