title: Cytomegalovirus and Epstein-Barr virus in breast milk are associated with HIV-1 shedding but not with mastitis.
abstract: BACKGROUND
  Breast milk HIV-1 load is associated with clinical and subclinical mastitis, and both milk viral load and mastitis are associated with increased mother-to-child-transmission of HIV-1 through breastfeeding. Bacterial infections may cause clinical mastitis, but whether other copathogens common in HIV-1 infection are associated with subclinical mastitis or HIV-1 shedding is unknown.
  
  
  METHODS
  A cross-sectional study of HIV-1-infected breastfeeding women in Zimbabwe was performed to examine the relationship between a wide range of breast coinfections, mastitis, and HIV-1 shedding.
  
  
  METHODS
  Breast milk was cultured for bacteria and fungi and tested by PCR for mycobacteria, mycoplasmas, human herpesvirus (HHV)-6, HHV-7, HHV-8, cytomegalovirus, Epstein-Barr virus, and HIV-1 RNA and DNA. Symptoms of clinical mastitis were documented and subclinical mastitis was identified by breast milk sodium concentration (Na) and leukocyte counts.
  
  
  RESULTS
  Coinfections of milk were not associated with clinical or subclinical mastitis in the 217 women studied. Detection of HIV-1 RNA, but not DNA, in breast milk was associated with cytomegalovirus concentration (odds ratio = 1.8, P = 0.002) and detection of Epstein-Barr virus (odds ratio = 3.8, P = 0.0003) but not other coinfections in multivariate analysis.
  
  
  CONCLUSIONS
  Coinfection of breast milk with bacteria, fungi, or herpes viruses was not associated with mastitis. The associations between shedding of cytomegalovirus and Epstein-Barr virus with HIV-1 in milk suggest a local interaction between herpes virus infection and HIV-1 independent of mastitis. Cytomegalovirus and Epstein-Barr virus infections may impact HIV-1 shedding in breast milk and the risk of MTCT.
authors.affiliation: Departments of Pediatrics, Seattle Children's Hospital Research Institute, 1900 Ninth Avenue, Seattle, WA 98101, USA. sgantt@u.washington.edu
authors.forename: Soren
authors.initials: S
authors.lastname: Gantt
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Carlsson
authors.forename: Avinash K
authors.initials: AK
authors.lastname: Shetty
authors.forename: Kristy D
authors.initials: KD
authors.lastname: Seidel
authors.forename: Xuan
authors.initials: X
authors.lastname: Qin
authors.forename: Junior
authors.initials: J
authors.lastname: Mutsvangwa
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: D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D001942:Breast Feeding; D003430:Cross-Sectional Studies; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications; D004279:DNA, Viral / Q000032:analysis; D020031:Epstein-Barr Virus Infections / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000635:transmission; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008413:Mastitis / Q000821:virology*; D008895:Milk, Human / Q000821:virology*; D012367:RNA, Viral / Q000032:analysis; D013048:Specimen Handling / Q000379:methods; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral