期刊
JOURNAL OF INFECTIOUS DISEASES
卷 190, 期 10, 页码 1880-1888出版社
OXFORD UNIV PRESS INC
DOI: 10.1086/425076
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资金
- FIC NIH HHS [D43 TW000007] Funding Source: Medline
- NCI NIH HHS [T32 CA 09229, T32 CA009229] Funding Source: Medline
- NIAID NIH HHS [P30 AI027757-15, P30 AI027757] Funding Source: Medline
- NICHD NIH HHS [K08 HD001160, R01 HD023412, HD-23412] Funding Source: Medline
Understanding how the level of human immunodeficiency virus type 1 (HIV-1)-infected breast milk cells (BMCs) affects HIV transmission via breast-feeding can shed light on the mechanism of infection and aid in establishing effective interventions. The proportion of infected cells to total cells was measured in serial breast milk samples collected from 291 HIV-1-infected women in Nairobi, Kenya, by use of real-time DNA polymerase chain reaction amplification of BMCs. The number of infected BMCs per million cells was associated with levels of cell-free viral RNA in breast milk (R = .144; P = .032), levels of cell-free virus in blood plasma (R = .365; P < .001), and the detection of proviral DNA in cervical and vaginal secretions (P < .001 and P = .030, respectively). The number of infected BMCs per million cells was lower in colostrum or early milk than in mature milk (P < .001). Previous studies demonstrated that the concentration of BMCs varies throughout lactation, and we used these data to transform infected BMCs per million cells to infected BMCs per milliliter. The estimated concentration of infected BMCs per milliliter was higher in colostrum or early milk than in mature milk (P < .001). Each log(10) increase in infected BMCs per milliliter was associated with a 3.19-fold-increased risk of transmission (P = .002), after adjustment for cell-free virus in plasma (hazard ratio [HR], 2.09; P = .03) and breast milk (HR, 1.01; P = 1.00). This suggests that infected BMCs may play a more important role in transmission of HIV via breast- feeding than does cell- free virus.
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