title: Infant morbidity, mortality, and breast milk immunologic profiles among breast-feeding HIV-infected and HIV-uninfected women in Botswana.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. rshapiro@bidmc.harvard.edu
authors.forename: Roger L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
authors.forename: Soyeon
authors.initials: S
authors.lastname: Kim
authors.forename: Laura
authors.initials: L
authors.lastname: Smeaton
authors.forename: Jeremy T
authors.initials: JT
authors.lastname: Rahkola
authors.forename: Ibou
authors.initials: I
authors.lastname: Thior
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wester
authors.forename: Claire
authors.initials: C
authors.lastname: Moffat
authors.forename: Peter
authors.initials: P
authors.lastname: Arimi
authors.forename: Patrick
authors.initials: P
authors.lastname: Ndase
authors.forename: Aida
authors.initials: A
authors.lastname: Asmelash
authors.forename: Lisa
authors.initials: L
authors.lastname: Stevens
authors.forename: Monty
authors.initials: M
authors.lastname: Montano
authors.forename: Joseph
authors.initials: J
authors.lastname: Makhema
authors.forename: Max
authors.initials: M
authors.lastname: Essex
authors.forename: Edward N
authors.initials: EN
authors.lastname: Janoff
mesh_terms: 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
chemical_list: D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M