title: Effect of Postnatal HIV Treatment on Clinical Mastitis and Breast Inflammation in HIV-Infected Breast-feeding Women.
abstract: The relationship between mastitis and antiretroviral therapy among HIV-positive, breast-feeding women is unclear.
  
  
  
  In the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study, conducted in Lilongwe, Malawi, 2369 mother-infant pairs were randomized to a nutritional supplement group and to one of three treatment groups: maternal antiretroviral therapy (ART), infant nevirapine (NVP) or standard of care for 24 weeks of exclusive breast-feeding and 4 weeks of weaning. Among 1472 HIV-infected women who delivered live infants between 2004 and 2007, we estimated cumulative incidence functions and sub-distribution hazard ratios (HR) of mastitis or breast inflammation comparing women in maternal ART (n = 487) or infant nevirapine (n = 492) groups to the standard of care (n = 493). Nutritional supplement groups (743 took, 729 did not) were also compared.
  
  
  
  Through 28-weeks post-partum, 102 of 1472 women experienced at least one occurrence of mastitis or breast inflammation. The 28-week risk was higher for maternal ART (risk difference (RD) 4.5, 95% confidence interval (CI) 0.9, 8.1) and infant NVP (RD 3.6, 95% CI 0.3, 6.9) compared to standard of care. The hazard of late-appearing mastitis or breast inflammation (from week 5-28) was also higher for maternal ART (HR 6.7, 95% CI 2.0, 22.6) and infant NVP (HR 5.1, 95% CI 1.5, 17. 5) compared to the standard of care.
  
  
  
  Mastitis or breast inflammation while breast-feeding is a possible side effect for women taking prophylactic ART and women whose infants take NVP, warranting additional research in the context of postnatal HIV transmission.
authors.affiliation: Carolina Population Center, Universitiy of North Carolina, Chapel Hill.|Department of Epidemiology, University of North Carolina, Chapel Hill.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Zadrozny
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill.
authors.forename: Daniel
authors.initials: D
authors.lastname: Westreich
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hudgens
authors.affiliation: University of Witwatersrand, Pretoria, South Africa.
authors.forename: Charles
authors.initials: C
authors.lastname: Chasela
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.affiliation: UNC Project, Lilongwe, Malawi.
authors.forename: Francis
authors.initials: F
authors.lastname: Martinson
authors.affiliation: UNC Project, Lilongwe, Malawi.
authors.forename: Chifundo
authors.initials: C
authors.lastname: Zimba
authors.affiliation: UNC Project, Lilongwe, Malawi.
authors.forename: Gerald
authors.initials: G
authors.lastname: Tegha
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill.
authors.forename: Irving
authors.initials: I
authors.lastname: Hoffman
authors.affiliation: College of Public Health, Division of Epidemiology, The Ohio State University, Columbus, OH.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Caroline C
authors.initials: CC
authors.lastname: King
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Athena P
authors.initials: AP
authors.lastname: Kourtis
authors.affiliation: Health Services Branch, Centers for Disease Control Malawi, Lilongwe, Malawi.
authors.forename: Wezi
authors.initials: W
authors.lastname: Msungama
authors.affiliation: UNC Project, Lilongwe, Malawi.
authors.forename: Charles
authors.initials: C
authors.lastname: van der Horst
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D001942:Breast Feeding; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008413:Mastitis / Q000139:chemically induced* / Q000453:epidemiology; D011181:Postnatal Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents
keywords: Mastitis; breast-feeding; human immunodeficiency virus; infant nevirapine; prophylactic antiretroviral therapy