title: Role of intestinal mucosal integrity in HIV transmission to infants through breast-feeding: the BAN study.
abstract: BACKGROUND
  Increased intestinal permeability may be one of the mechanisms of transmission of human immunodeficiency virus (HIV) to infants through breast-feeding. Intestinal permeability correlates with microbial translocation, which can be measured through quantification of bacterial lipopolysaccharide (LPS).
  
  
  METHODS
  We evaluated levels of plasma LPS (by the Limulus amebocyte lysate assay) and immune activation markers in serial specimens from infants exposed to but uninfected with HIV and infants infected with HIV from the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study.
  
  
  RESULTS
  Plasma LPS levels increased after infants in the BAN study were weaned from the breast, at 24 weeks of age. Cotrimoxazole prophylaxis was associated with higher plasma LPS levels (P = .004). Infants with HIV infection had higher LPS levels, compared with uninfected infants (P = .004). Higher preinfection plasma LPS levels were a significant predictor of infant HIV infection through breast-feeding (hazard ratio = 1.60 for every unit increase in plasma LPS level; P = .01) and of lower infant length-for-age z scores (P = .02).
  
  
  CONCLUSIONS
  These findings suggest that disruption in intestinal integrity is a mechanism of HIV transmission to infants through breast-feeding. Weaning from breast milk and use of antibiotic prophylaxis was associated with increased levels of microbial translocation, which could facilitate HIV entry through the intestine. Complementary approaches to enhance intestinal mucosal integrity in the infant may further reduce breast-feeding transmission of HIV.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. apk3@cdc.gov
authors.forename: Athena P
authors.initials: AP
authors.lastname: Kourtis
authors.forename: Chris C
authors.initials: CC
authors.lastname: Ibegbu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wiener
authors.forename: Caroline C
authors.initials: CC
authors.lastname: King
authors.forename: Gerald
authors.initials: G
authors.lastname: Tegha
authors.forename: Deborah
authors.initials: D
authors.lastname: Kamwendo
authors.forename: Jacob
authors.initials: J
authors.lastname: Kumwenda
authors.forename: Surinder P
authors.initials: SP
authors.lastname: Kaur
authors.forename: Valerie
authors.initials: V
authors.lastname: Flax
authors.forename: Sascha
authors.initials: S
authors.lastname: Ellington
authors.forename: Zebrone
authors.initials: Z
authors.lastname: Kacheche
authors.forename: Dumbani
authors.initials: D
authors.lastname: Kayira
authors.forename: Charles
authors.initials: C
authors.lastname: Chasela
authors.forename: Charles
authors.initials: C
authors.lastname: van der Horst
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D018988:Bacterial Translocation; D001942:Breast Feeding; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007413:Intestinal Mucosa / Q000276:immunology* / Q000502:physiology*; D008033:Limulus Test; D008070:Lipopolysaccharides / Q000097:blood; D008297:Male; D011247:Pregnancy
chemical_list: D008070:Lipopolysaccharides
keywords: HIV; breast-feeding; immune activation; infant; intestinal permeability; microbial translocation