title: Laboratory indicators of mastitis are not associated with elevated HIV-1 DNA loads or predictive of HIV-1 RNA loads in breast milk.
abstract: BACKGROUND
  Mother-to-child transmission (MTCT) of HIV-1 has been associated with symptomatic and asymptomatic mastitis and with the quantity of HIV-1 RNA and DNA in maternal milk. An improved understanding of the relationship between indicators of inflammation and HIV-1 loads in breast milk could improve MTCT prevention strategies.
  
  
  METHODS
  In a cross-sectional study, laboratory indicators of mastitis (breast milk sodium [Na(+)] concentration, sodium : potassium ratio [Na(+) : K(+)], and leukocyte count) were related to breast milk HIV-1 RNA and DNA loads and were evaluated for predicting viral loads in milk.
  
  
  RESULTS
  Mastitis was present in 63 (15%) of 407, 60 (15%) of 407, and 76 (18%) of 412 milk specimens, as defined by Na(+) concentration >12 mmol/L, Na(+) : K(+) >1, and total leukocyte counts > or =10(6) cells/mL, respectively. Each indicator was associated with an increased milk HIV-1 RNA load (P<.05) but not with HIV-1 DNA load. Neutrophils correlated better with milk HIV-1 RNA load than total leukocytes. However, neither neutrophil count, Na(+) concentration, nor Na(+) : K(+) displayed a threshold that was both sensitive and specific for the detection of HIV-1 RNA in milk at thresholds of > or =50 or > or =10(4) copies/mL.
  
  
  CONCLUSIONS
  HIV-1 DNA loads in breast milk were not increased during mastitis. Neither milk cell counts nor electrolyte concentrations were useful predictors of milk HIV-1 RNA or DNA loads for individual women.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA 98109, USA. sgantt@u.washington.edu
authors.forename: Soren
authors.initials: S
authors.lastname: Gantt
authors.forename: Avinash K
authors.initials: AK
authors.lastname: Shetty
authors.forename: Kristy D
authors.initials: KD
authors.lastname: Seidel
authors.forename: Kuda
authors.initials: K
authors.lastname: Matasa
authors.forename: Georgina
authors.initials: G
authors.lastname: Musingwini
authors.forename: Godfrey
authors.initials: G
authors.lastname: Woelk
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Zijenah
authors.forename: David A
authors.initials: DA
authors.lastname: Katzenstein
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Frenkel
mesh_terms: D001942:Breast Feeding / Q000009:adverse effects; D002452:Cell Count; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000235:genetics; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007962:Leukocytes / Q000166:cytology; D008413:Mastitis / Q000175:diagnosis* / Q000821:virology*; D008895:Milk, Human / Q000737:chemistry / Q000276:immunology / Q000821:virology; D016133:Polymerase Chain Reaction; D011188:Potassium / Q000032:analysis; D012367:RNA, Viral / Q000235:genetics; D012964:Sodium / Q000032:analysis; D015030:Zimbabwe
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral; D012964:Sodium; D011188:Potassium