To examine the prevalence, quantification, and factors that influence HIV in the cell-free compartment of breast milk, we performed reverse transcription polymerase chain reaction (RT-PCR) on samples obtained from HIV-1-infected study subjects. Virus was detected in 86 of 136 samples (63.2%) from 79 study subjects. HIV RNA quantity ranged from undetectable to 227,586 copies/ml. Prevalence and mean viral load were not affected by postnatal ages or maternal vitamin A supplementation. Among study subjects with multiple samples, breast milk viral load did not change at different postnatal ages. Breast milk viral load correlated positively with plasma viral load (r = 0.47; p = .005) and negatively with maternal CD4 count at entry to the study (r = -0.26; p = .02). Mothers of HIV-infected children had a higher proportion of detectable HIV RNA in their breast milk than mothers of uninfected children (p = .03) and higher mean log10 HIV RNA quantities (p = .04). In a multivariate logistic regression model, log10 HIV RNA quantity in breast milk was significantly associated with the risk of mother-child transmission (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.22-6.51). Thus, prevention and treatment of opportunistic infections and of mastitis and early weaning may be important elements of a public health policy that is relevant to women in developing countries with HIV infection. Where available, antiretrovirals may also have an impact on opportunistic infections and mastitis.
Address correspondence and reprint requests to Kubendran Pillay, Department of Paediatrics and Child Health, University of Natal, Private Bag 7, Congelia 4013, South Africa.
Manuscript received February 2, 2000; accepted March 27, 2000.
© 2000 Lippincott Williams & Wilkins, Inc.