title: Highly active antiretroviral therapy started during pregnancy or postpartum suppresses HIV-1 RNA, but not DNA, in breast milk.
abstract: BACKGROUND
  The ability of highly active antiretroviral therapy (HAART) to reduce human immunodeficiency virus type 1 (HIV-1) RNA and DNA in breast milk has not been described.
  
  
  METHODS
  We compared breast-milk HIV-1 RNA and DNA loads of women in Botswana who received HAART (nevirapine, lamivudine, and zidovudine) and women who did not receive HAART.
  
  
  RESULTS
  Women in the HAART group received treatment for a median of 98 days (range, 67-222 days) at the time of breast-milk sampling; 23 (88%) of 26 had whole breast-milk HIV-1 RNA loads <50 copies/mL, compared with 9 (36%) of 25 women who did not receive HAART (P=.0001). This finding remained significant in a multivariate logistic-regression model (P = .0006). The whole-milk HIV-1 DNA load was unaffected by HAART. Of women who received HAART, 13 (50%) of 26 had HIV-1 DNA loads <10 copies/10(6) cells, compared with 15 (65%) of 23 who did not receive HAART (P = .39).
  
  
  CONCLUSIONS
  HAART suppressed cell-free HIV-1 RNA in breast milk and may therefore reduce mother-to-child transmission (MTCT) of HIV-1 via breast-feeding. However, HAART initiated during pregnancy or early after delivery had no apparent effect on cell-associated HIV-1 DNA loads in breast milk. Clinical trials to determine MTCT among breast-feeding women receiving HAART are needed.
authors.affiliation: Department of Immunology and Infectious Diseases, Harvard School of Public Health, and Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. rshapiro@bidmc.harvard.edu
authors.forename: Roger L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: Thumbi
authors.initials: T
authors.lastname: Ndung'u
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
authors.forename: Laura M
authors.initials: LM
authors.lastname: Smeaton
authors.forename: Ibou
authors.initials: I
authors.lastname: Thior
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wester
authors.forename: Lisa
authors.initials: L
authors.lastname: Stevens
authors.forename: Gaseene
authors.initials: G
authors.lastname: Sebetso
authors.forename: Simani
authors.initials: S
authors.lastname: Gaseitsiwe
authors.forename: Trevor
authors.initials: T
authors.lastname: Peter
authors.forename: Max
authors.initials: M
authors.lastname: Essex
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001902:Botswana; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood / Q000378:metabolism*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism / Q000821:virology; D015497:HIV-1 / Q000235:genetics* / Q000254:growth & development; D006801:Humans; D007223:Infant; D007774:Lactation / Q000378:metabolism*; D016015:Logistic Models; D008895:Milk, Human / Q000378:metabolism / Q000821:virology*; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology; D012367:RNA, Viral / Q000097:blood / Q000378:metabolism*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral