title: Dynamics of breast milk HIV-1 RNA with unilateral mastitis or abscess.
abstract: BACKGROUND
  Mastitis and abscess in HIV-infected women increase the risk of breastfeeding transmission of HIV. Guidelines encourage women to stop breastfeeding on the affected breast and feed on the contralateral breast. However, impact of breast pathology on breast milk HIV dynamics is unknown.
  
  
  METHODS
  HIV RNA was quantified in 211 breast milk samples collected before, during, and after a clinical mastitis or an abscess diagnosis from 38 HIV-infected women participating in a Zambian breastfeeding study. HIV RNA quantity was compared between affected and unaffected breasts over time using generalized estimating equation models. A sample of 115 women without breast pathology was selected as a control group.
  
  
  RESULTS
  In the affected breast, breast milk HIV RNA quantity increased from the pre- to during-pathology period by log(10) 0.45 copies per milliliter [95% confidence interval (CI): 0.16 to 0.74], and after symptom resolution, HIV RNA levels were no different from prepathology levels (log10 -0.04 copies per milliliter 95% CI: -0.33 to 0.25). In the contralateral, unaffected breast, HIV RNA quantity did not significantly increase (log(10) 0.15 copies per milliliter, 95% CI: -0.41 to 0.10). Increase was more marked in women with abscess or with a greater number of mastitis symptoms. HIV RNA was not significantly different between affected and unaffected women, except at the time of diagnosis.
  
  
  CONCLUSIONS
  Breast milk HIV RNA increased modestly in the affected breast with unilateral mastitis or abscess and returned to prepathology levels with symptom resolution. Contralateral HIV RNA was not affected. Results support guidelines encouraging feeding from the contralateral breast to minimize the risk of HIV transmission associated with unilateral breast pathology.
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Boston, MA 02118, USA. ksemrau@bu.edu
authors.forename: Katherine
authors.initials: K
authors.lastname: Semrau
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Brooks
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.forename: Grace M
authors.initials: GM
authors.lastname: Aldrovandi
mesh_terms: D000038:Abscess / Q000821:virology*; D000328:Adult; D001941:Breast Diseases / Q000821:virology*; D001942:Breast Feeding / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000635:transmission / Q000821:virology*; D015497:HIV-1; D006801:Humans; D008413:Mastitis / Q000821:virology; D008895:Milk, Human / Q000821:virology*; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis*
chemical_list: D012367:RNA, Viral