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Dynamics of Breast Milk HIV-1 RNA With Unilateral Mastitis or Abscess

Semrau, Katherine PhD, MPH*; Kuhn, Louise PhD†,‡; Brooks, Daniel R. DSC§; Cabral, Howard PhD, MPH; Sinkala, Moses MD, MPH; Kankasa, Chipepo MD#; Thea, Donald M. MD, MSC*; Aldrovandi, Grace M. MD**

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1st, 2013 - Volume 62 - Issue 3 - p 348–355
doi: 10.1097/QAI.0b013e31827e64d4
Epidemiology and Prevention

Background: Mastitis and abscess in HIV-infected women increase the risk of breastfeeding transmission of HIV. Guidelines encourage women to stop breastfeeding on the affected breast and feed on the contralateral breast. However, impact of breast pathology on breast milk HIV dynamics is unknown.

Methods: HIV RNA was quantified in 211 breast milk samples collected before, during, and after a clinical mastitis or an abscess diagnosis from 38 HIV-infected women participating in a Zambian breastfeeding study. HIV RNA quantity was compared between affected and unaffected breasts over time using generalized estimating equation models. A sample of 115 women without breast pathology was selected as a control group.

Results: In the affected breast, breast milk HIV RNA quantity increased from the pre- to during-pathology period by log10 0.45 copies per milliliter [95% confidence interval (CI): 0.16 to 0.74], and after symptom resolution, HIV RNA levels were no different from prepathology levels (log10 −0.04 copies per milliliter 95% CI: −0.33 to 0.25). In the contralateral, unaffected breast, HIV RNA quantity did not significantly increase (log10 0.15 copies per milliliter, 95% CI: −0.41 to 0.10). Increase was more marked in women with abscess or with a greater number of mastitis symptoms. HIV RNA was not significantly different between affected and unaffected women, except at the time of diagnosis.

Conclusions: Breast milk HIV RNA increased modestly in the affected breast with unilateral mastitis or abscess and returned to prepathology levels with symptom resolution. Contralateral HIV RNA was not affected. Results support guidelines encouraging feeding from the contralateral breast to minimize the risk of HIV transmission associated with unilateral breast pathology.

*Center for Global Health and Development, Boston University School of Public Health, Boston, MA

Gertrude H. Sergievsky Center and

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY

Departments of §Epidemiology

Biostatistics, Boston University School of Public Health, Boston, MA

Lusaka District Health Management Team, Sinkala is now with Catholic Medical Mission Board, Lusaka, Zambia

#University Teaching Hospital, University of Zambia, Lusaka, Zambia

**Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA

Correspondence to: Katherine Semrau, PhD, MPH, Center for Global Health & Development, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118 (e-mail:

Presented in part at the 15th Conference on Retrovirus and Opportunistic Infection, Boston, MA, February 3–6, 2008; Poster #650.

Supported by grants R01 HD 39611, R01 HD 40777, and R01 HD057617 from the National Institute of Child Health and Human Development.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received June 27, 2012

Accepted October 28, 2012

© 2013 Lippincott Williams & Wilkins, Inc.