Title: Cumulative exposure to cell-free HIV in breast milk, rather than feeding pattern per se, identifies postnatally infected infants
Authors: Neveu D, Viljoen J, Bland RM, Nagot N, Danaviah S, Coutsoudis A, Rollins NC, Coovadia HM, Van de Perre P, Newell ML. .
Journal: Clin Infect Dis,52(6):819-25 (2011)
Journal Impact Factor (I.F.): 9.374
Background. We quantified the relationship between human immunodeficiency virus (HIV) RNA shedding in
breast milk, cumulative RNA exposure, and postnatal transmission, relating timing of infection in the infant to
estimated total volume of milk exposure.
Methods. Nested case-control study of 36 infants of HIV-infected mothers. Case patients were infants who
acquired HIV infection through breastfeeding from age 6 through 28 weeks, and control subjects were uninfected
infants matched on age at obtainment of a breast milk sample. Mothers and infants received peripartum single-dose
nevirapine prophylaxis. Feeding data were collected daily; breast milk samples were collected and infant
anthropometry was performed at 6 weeks and monthly thereafter. Volume of milk ingested was estimated using
infant weight and feeding pattern.
Results. Before HIV acquisition in case patients, feeding pattern (exclusive breastfeeding; median duration, 65
vs 70 days; P 5 .6) and daily milk intake (mean volume, 638 vs 637 mL; P 5 .97) did not differ significantly between
case patients and control subjects. Case mothers were more likely to shed virus (64% vs 9% always, 22% vs 20.5%
intermittently, 14% vs 70.5% never shed; overall, P .001). Case patients ingested 15 times more HIV-1 RNA
particles than did control subjects (196.5 vs 13 3 106 copies; P .001). Allowing for maternal antenatal CD4 cell
count and plasma HIV-1 load, child sex and duration of mixed breastfeeding, the association between HIV RNA
exposure and infection remained statistically significant (P .001).
Conclusions. Postnatal acquisition of HIV-1 is more strongly associated with cumulative exposure to cell-free
particles in breast milk than with feeding mode. Reducing breast milk viral load through antiretroviral therapy to
mother or child can further decrease postnatal transmission in exclusively breastfed infants.
Citation: Neveu D, Viljoen J, Bland RM, Nagot N, Danaviah S, Coutsoudis A, Rollins NC, Coovadia HM, Van de Perre P, Newell ML. . Cumulative exposure to cell-free HIV in breast milk, rather than feeding pattern per se, identifies postnatally infected infants Clin Infect Dis,52(6):819-25 (2011).