title: Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease.
abstract: Transmission of human immunodeficiency virus type 1 (HIV-1) via breast-feeding can occur throughout lactation. Defining both fluctuation in breast-milk virus level over time and how breast-milk virus correlates with mother-to-child transmission is important for establishing effective interventions. We quantified breast-milk HIV-1 RNA levels in serial samples collected from 275 women for up to 2 years after delivery. Higher maternal plasma virus load, lower maternal CD4 T cell count, and detection of HIV-1 DNA in maternal genital secretions were significantly associated with elevated breast-milk HIV-1 RNA. Within women who breast-fed, median virus load in colostrum/early milk was significantly higher than that in mature breast milk collected 14 days after delivery (P< or =.004). Breast-feeding mothers who transmitted HIV-1 to their infants had both significantly higher breast-milk viral RNA throughout lactation and more-consistent viral shedding, compared with mothers who did not transmit HIV-1. In breast-feeding women, a 2-fold-increased risk of transmission was associated with every 10-fold increase in breast-milk virus load (95% confidence interval, 1.3-3.0; P<.001). These results indicate that the risk of infant infection from breast-feeding is influenced by breast-milk virus load, which is highest early after delivery.
authors.affiliation: Department of Human Biology, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue, Seattle, WA 98109-1024, USA. joverbau@fhcrc.org
authors.forename: Christine M
authors.initials: CM
authors.lastname: Rousseau
authors.forename: Ruth W
authors.initials: RW
authors.lastname: Nduati
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Steele
authors.forename: Grace C
authors.initials: GC
authors.lastname: John-Stewart
authors.forename: Dorothy A
authors.initials: DA
authors.lastname: Mbori-Ngacha
authors.forename: Joan K
authors.initials: JK
authors.lastname: Kreiss
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
mesh_terms: D001942:Breast Feeding; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000502:physiology*; D006801:Humans; D007223:Infant; D007225:Infant Food; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008137:Longitudinal Studies; D008895:Milk, Human / Q000821:virology*; D011247:Pregnancy; D012367:RNA, Viral / Q000032:analysis* / Q000097:blood; D019562:Viral Load; D017201:Virus Shedding
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral