title: Incidence and correlates of HIV-1 RNA detection in the breast milk of women receiving HAART for the prevention of HIV-1 transmission.
abstract: BACKGROUND
  The incidence and correlates of breast milk HIV-1 RNA detection were determined in intensively sampled women receiving highly active antiretroviral therapy (HAART) for the prevention of mother-to-child HIV-1 transmission.
  
  
  METHODS
  Women initiated HAART at 34 weeks of pregnancy. Breast milk was collected every 2-5 days during 1 month postpartum for measurements of cell-associated HIV DNA and cell-free HIV RNA. Plasma and breast milk were also collected at 2 weeks, 1, 3 and 6 months for concurrent HIV-1 RNA and DNA measurements. Regression was used to identify cofactors for breast milk HIV-1 RNA detection.
  
  
  RESULTS
  Of 259 breast milk specimens from 25 women receiving HAART, 34 had detectable HIV-1 RNA (13%, incidence 1.4 episodes/100 person-days 95% CI = 0.97-1.9). Fourteen of 25 (56%) women had detectable breast milk HIV-1 RNA [mean 2.5 log(10) copies/ml (range 2.0-3.9)] at least once. HIV-1 DNA was consistently detected in breast milk cells despite HAART, and increased slowly over time, at a rate of approximately 1 copy/10(6) cells per day (p = 0.02). Baseline CD4, plasma viral load, HAART duration, and frequency of breast problems were similar in women with and without detectable breast milk HIV-1 RNA. Women with detectable breast milk HIV-1 RNA were more likely to be primiparous than women without (36% vs 0%, p = 0.05). Plasma HIV-1 RNA detection (OR = 9.0, 95%CI = 1.8-44) and plasma HIV-1 RNA levels (OR = 12, 95% CI = 2.5-56) were strongly associated with concurrent detection of breast milk HIV-1 RNA. However, no association was found between breast milk HIV-1 DNA level and concurrent breast milk HIV-1 RNA detection (OR = 0.96, 95%CI = 0.54-1.7).
  
  
  CONCLUSIONS
  The majority of women on HAART had episodic detection of breast milk HIV-1 RNA. Breast milk HIV-1 RNA detection was associated with systemic viral burden rather than breast milk HIV-1 DNA.
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, United States of America. jslyker@uw.edu
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Slyker
authors.forename: Michael H
authors.initials: MH
authors.lastname: Chung
authors.forename: Dara A
authors.initials: DA
authors.lastname: Lehman
authors.forename: James
authors.initials: J
authors.lastname: Kiarie
authors.forename: John
authors.initials: J
authors.lastname: Kinuthia
authors.forename: Sarah
authors.initials: S
authors.lastname: Holte
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tapia
authors.forename: Francis
authors.initials: F
authors.lastname: Njiri
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission* / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya / Q000453:epidemiology; D008895:Milk, Human / Q000166:cytology / Q000821:virology*; D012367:RNA, Viral / Q000032:analysis* / Q000097:blood; D019562:Viral Load; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral