Laboratory Indicators of Mastitis Are Not Associated with Elevated HIV-1 DNA Loads or Predictive of HIV-1 RNA Loads in Breast Milk

• Published in: The Journal of infectious diseases Vol. 196; no. 4; pp. 570 - 576
• Main Authors: Gantt, Soren, Shetty, Avinash K., Seidel, Kristy D., Matasa, Kuda, Musingwini, Georgina, Woelk, Godfrey, Zijenah, Lynn S., Katzenstein, David A., Frenkel, Lisa M.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15-08-2007; University of Chicago Press
• Subjects: Biological and medical sciences; Breast Feeding - adverse effects; Breast milk; Breasts; Cell Count; Cross-Sectional Studies; Disease Transmission, Infectious - prevention & control; DNA; DNA, Viral - genetics; Female; Fundamental and applied biological sciences. Psychology; HIV 1; HIV Infections - etiology; HIV Infections - prevention & control; HIV Infections - transmission; HIV-1 - genetics; HIV-1 - isolation & purification; HIV/AIDS; Human immunodeficiency virus 1; Humans; Leukocytes; Leukocytes - cytology; Lymphocytes; Mastitis; Mastitis - diagnosis; Mastitis - virology; Microbiology; Milk, Human - chemistry; Milk, Human - immunology; Milk, Human - virology; Miscellaneous; Neutrophils; Polymerase Chain Reaction; Potassium - analysis; RNA; RNA, Viral - genetics; Sodium - analysis; Virology; Women; Zimbabwe; Zimbabwe; Virus; Mammary gland diseases; Mastitis; HIV-1 virus; Retroviridae; Human immunodeficiency virus; Lentivirus; Milk
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/519843

Background. Mother-to-child transmission (MTCT) of HIV-1 has been associated with symptomatic and asymptomatic mastitis and with the quantity of HIV-1 RNA and DNA in maternal milk. An improved understanding of the relationship between indicators of inflammation and HIV-1 loads in breast milk could improve MTCT prevention strategies. Methods. In a cross-sectional study, laboratory indicators of mastitis (breast milk sodium [Na+] concentration, sodium:potassium ratio [Na+:K+], and leukocyte count) were related to breast milk HIV-1 RNA and DNA loads and were evaluated for predicting viral loads in milk. Results. Mastitis was present in 63 (15%) of 407, 60 (15%) of 407, and 76 (18%) of 412 milk specimens, as defined by Na+ concentration >12 mmol/L, Na+:K+ >1, and total leukocyte counts ⩾106 cells/mL, respectively. Each indicator was associated with an increased milk HIV-1 RNA load (P < .05) but not with HIV-1 DNA load. Neutrophils correlated better with milk HIV-1 RNA load than total leukocytes. However, neither neutrophil count, Na+ concentration, nor Na+:K+ displayed a threshold that was both sensitive and specific for the detection of HIV-1 RNA in milk at thresholds of ⩾50 or ⩾104 copies/mL. Conclusions. HIV-1 DNA loads in breast milk were not increased during mastitis. Neither milk cell counts nor electrolyte concentrations were useful predictors of milk HIV-1 RNA or DNA loads for individual women.