title: Post-weaning breast milk HIV-1 viral load, blood prolactin levels and breast milk volume.
abstract: BACKGROUND
  The effect of abrupt weaning, advocated as a safe transition from exclusive breastfeeding in HIV-exposed children, on the quantity of HIV viral load in breast milk (BMVL) is not known.
  
  
  OBJECTIVE
  To determine the effect of abrupt cessation of breastfeeding on serum prolactin, pumped breast milk volume and BMVL obtained 2 weeks after rapid weaning in HIV-infected women.
  
  
  METHODS
  Women enrolled in a prospective study (ZEBS) were randomized to abruptly wean at 20 weeks postpartum or continue exclusive breastfeeding. Breast milk was obtained at 22 weeks by electric breast pump over 10 min from 222 women who had either weaned or continued to breastfeed. Pre- and post-pumping prolactin was measured. BMVL was measured at 20 and 22 weeks in 71 randomly selected women from both groups.
  
  
  RESULTS
  Baseline prolactin and breast milk volume was significantly lower among women who had weaned. Detectable (68 versus 42%; P = 0.03) and median BMVL (448 versus < 50 copies/ml; P = 0.005) was significantly higher among those who had weaned in comparison with those who were still breastfeeding and was significantly higher in the same women after weaning compared with 2 weeks earlier (P = 0.001).
  
  
  CONCLUSIONS
  BMVL is substantially higher after rapid weaning and this may pose an increased risk of HIV transmission if children resume breastfeeding after a period of cessation. Increases in BMVL with differing degrees of mixed feeding needs to be assessed.
authors.affiliation: Center for International Health and Development at the Boston University School of Public Health, Boston, Massachusetts, USA. dthea@bu.edu
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.forename: Grace
authors.initials: G
authors.lastname: Aldrovandi
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.forename: Prisca
authors.initials: P
authors.lastname: Kasonde
authors.forename: W Donald
authors.initials: WD
authors.lastname: Decker
authors.forename: Katherine
authors.initials: K
authors.lastname: Semrau
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000009:adverse effects; D005260:Female; D005516:Food Microbiology; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008895:Milk, Human / Q000821:virology*; D010349:Patient Compliance; D011388:Prolactin / Q000097:blood*; D013997:Time Factors; D019562:Viral Load; D014886:Weaning
chemical_list: D011388:Prolactin