Infant morbidity, mortality, and breast milk immunologic profiles among breast-feeding HIV-infected and HIV-uninfected women in Botswana.
BACKGROUND
Infants of human immunodeficiency virus (HIV)-infected women have high mortality, but the immunologic integrity and protection afforded by the breast milk of HIV-infected women is unknown.


METHODS
We determined morbidity and mortality by 24 months among breast-fed infants of 588 HIV-infected and 137 HIV-uninfected women followed-up in a clinical trial in Botswana. A matched case-control study compared clinical, behavioral, and breast milk immunologic parameters among 120 HIV-infected women by infant outcome. Breast milk factors were also compared between HIV-infected and HIV-uninfected women.


RESULTS
Twenty-four-month mortality was 29.5% among HIV-infected infants, 6.7% among HIV-exposed uninfected infants, and 1.6% among HIV-unexposed infants. No differences were detected in breast milk immunologic profiles of HIV-infected women whose infants were either ill or well. Discontinuation of breast-feeding was the strongest predictor of illness (P<.001). Levels in breast milk of pathogen-specific immunoglobulin (Ig) G and IgA to Haemophilus influenzae, Campylobacter jejuni, Helicobacter pylori, Streptococcus pneumoniae, and innate immune factors were not lower among HIV-infected women than among HIV-uninfected women.


CONCLUSIONS
Mortality was higher among HIV-infected and HIV-exposed infants than among HIV-unexposed infants. However, the immunologic profiles of breast milk among HIV-infected women were intact, and discontinuation of breast-feeding was the primary risk for infant morbidity. Thus, the breast milk of HIV-infected women may confer protection against common infant pathogens.


BACKGROUND
(ClinicalTrials.Gov) identifiers: NCT00197691 and NCT00197652.
Shapiro
Roger L
RL
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. rshapiro@bidmc.harvard.edu
Lockman
Shahin
S
Kim
Soyeon
S
Smeaton
Laura
L
Rahkola
Jeremy T
JT
Thior
Ibou
I
Wester
Carolyn
C
Moffat
Claire
C
Arimi
Peter
P
Ndase
Patrick
P
Asmelash
Aida
A
Stevens
Lisa
L
Montano
Monty
M
Makhema
Joseph
J
Essex
Max
M
Janoff
Edward N
EN
D000907:Antibodies, Bacterial / Q000032:analysis / Q000276:immunology; D000918:Antibody Specificity; D001902:Botswana / Q000453:epidemiology; D001942:Breast Feeding; D016123:Campylobacter jejuni / Q000276:immunology; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology*; D015497:HIV-1; D006193:Haemophilus influenzae / Q000276:immunology; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D007113:Immunity, Innate; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D007223:Infant; D008895:Milk, Human / Q000276:immunology* / Q000382:microbiology*; D011247:Pregnancy; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000276:immunology
D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M