Temporal and lateral dynamics of HIV shedding and elevated sodium in breast milk among HIV-positive mothers during the first 4 months of breast-feeding.
OBJECTIVE
To better understand the dynamics of breast milk HIV shedding and its relation to postnatal HIV transmission, we investigated the temporal and lateral relations of breast milk viral shedding and sodium concentrations in HIV-positive women.


METHODS
This was a longitudinal cohort study in Lusaka, Zambia.


METHODS
We examined patterns of HIV shedding in breast milk over the first 4 months of breast-feeding and their correlations with postnatal HIV transmission among 138 breast-feeding mothers. Sodium concentration in breast milk was also examined in the same samples and in breast milk from 23 HIV-negative controls.


RESULTS
Higher breast milk viral load at 1 week, 1 month, and 4 months and consistent viral shedding in breast milk were significantly associated with increased risk of HIV transmission. Elevated breast milk sodium concentration (> or =13 mmol/L) at 4 months was associated with HIV transmission, low maternal CD4 cell count, and high maternal plasma viral load. Elevated sodium concentration at 1 week postpartum was common and was not associated with any of these parameters.


CONCLUSIONS
Consistent viral shedding and high breast milk viral load are strong predictors of mother-to-child HIV transmission. Although sodium concentrations later in breast-feeding correlate with breast milk viral load, increased breast milk sodium is normal in early lactation and does not predict HIV transmission.
Semrau
Katherine
K
Center for International Health and Development at the Boston University School of Public Health, Boston, Massachusetts, USA.
Ghosh
Mrinal
M
Kankasa
Chipepo
C
Sinkala
Moses
M
Kasonde
Prisca
P
Mwiya
Mwiya
M
Thea
Donald M
DM
Kuhn
Louise
L
Aldrovandi
Grace M
GM
D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008895:Milk, Human / Q000821:virology; D019829:Nevirapine / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control / Q000821:virology; D012367:RNA, Viral / Q000097:blood / Q000235:genetics; D012964:Sodium / Q000097:blood; D013997:Time Factors; D019562:Viral Load
D012367:RNA, Viral; D019829:Nevirapine; D012964:Sodium