title: Maternal Highly Active Antiretroviral Therapy Reduces Vertical Cytomegalovirus Transmission But Does Not Reduce Breast Milk Cytomegalovirus Levels.
abstract: To evaluate the impact of highly active antiretroviral therapy (HAART) on CMV transmission and breast milk level in the context of maternal HIV. Specimens from a randomized trial conducted in Nairobi, Kenya between 2003-2005 were used to compare CMV transmission and breast milk levels between mother-infant pairs randomized to HAART versus short-course antenatal zidovudine plus single-dose nevirapine (ZDV/sdNVP) for prevention of mother-to-child HIV transmission (PMTCT). Fifty-one antiretroviral-naïve women ≤32 weeks gestation, and CD4 between 200-500 cells/mm3were randomized at 34 weeks to begin either antenatal ZDV/sdNVP, or HAART through 6 months postpartum. Mean breast milk CMV levels and transmission were compared between arms. Age, sociodemographics, CD4%, and HIV plasma RNA viral load were similar between arms at baseline. CMV viral loads were measured from 243 infant plasma and 185 breast milk specimens during the first year postpartum. The probability of infant CMV infection at 12 months was 19% lower in the HAART arm compared to ZDV/sdNVP (75% vs. 94%, p = .04). All women had CMV detected in breast milk, with 72%, 98%, and 97% testing positive during the first, second, and third weeks postpartum, respectively. There was a trend for early higher mean breast milk CMV level in the HAART arm at 1 week (p = .08), and there was significantly slower decline in breast milk CMV levels (area under the curve, p = .01). HAART started during the third trimester may decrease infant CMV infections, by mechanisms independent of breast milk CMV levels.
  
  
  
  NCT00167674.
authors: 1 Department of Global Health, University of Washington , Seattle, Washington.
authors: Jennifer A
authors: JA
authors: Slyker
authors: 2 Department of Biostatistics, University of Washington , Seattle, Washington.|3 Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center , Seattle, Washington.
authors: Barbra
authors: B
authors: Richardson
authors: 1 Department of Global Health, University of Washington , Seattle, Washington.|4 Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington , Seattle, Washington.|5 Department of Epidemiology, University of Washington , Seattle, Washington.
authors: Michael H
authors: MH
authors: Chung
authors: 6 Institute for Immunity and Transplantation, University College , London, London, United Kingdom .
authors: Claire
authors: C
authors: Atkinson
authors: 5 Department of Epidemiology, University of Washington , Seattle, Washington.
authors: Kristjana H
authors: KH
authors: Ásbjörnsdóttir
authors: 1 Department of Global Health, University of Washington , Seattle, Washington.|7 Human Biology Division, Fred Hutchinson Cancer Research Center , Seattle, Washington.
authors: Dara A
authors: DA
authors: Lehman
authors: 4 Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington , Seattle, Washington.|8 Vaccine and Infectious Disease and Clinical Research Divisions, Fred Hutchinson Cancer Research Center , Seattle, Washington.
authors: Michael
authors: M
authors: Boeckh
authors: 9 Department of Microbial and Cellular Sciences, University of Surrey , Guildford, United Kingdom .
authors: Vincent
authors: V
authors: Emery
authors: 10 Department of Obstetrics and Gynaecology, School of Medicine, University of Nairobi , Nairobi, Kenya .
authors: James
authors: J
authors: Kiarie
authors: 1 Department of Global Health, University of Washington , Seattle, Washington.|4 Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington , Seattle, Washington.|5 Department of Epidemiology, University of Washington , Seattle, Washington.|11 Department of Pediatrics, University of Washington , Seattle, Washington.
authors: Grace
authors: G
authors: John-Stewart
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D008895:Milk, Human / Q000821:virology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D019562:Viral Load; D055815:Young Adult
keywords: HAART; antiretroviral therapy; breast milk; cytomegalovirus; human immunodeficiency virus; neonates