Infant Feeding Practices were not Associated with Breast Milk HIV-1 RNA Levels in a Randomized Clinical Trial in Botswana
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Exclusive breastfeeding has been associated with a reduced risk of late vertical HIV transmission as compared to an infant diet composed of breast milk mixed with supplemental foods or liquids. Hypothesized mechanisms include increased infectivity of breast milk from mothers who practice mixed breastfeeding (MBF), or mechanisms such as increased gastrointestinal permeability in the infant caused by mixed feeding. It has been proposed that MBF may result in subclinical mastitis and higher breast milk HIV titers. However, little is known about the relationship between feeding strategy and breast milk viral load. We measured the HIV-1 concentration in breast milk in a sub-cohort of women enrolled in a mother-to-child HIV transmission prevention trial (the “Mashi” study). We report no observed relationship between MBF and measured breast milk viral RNA load. Our findings suggest that the increased transmission risk associated with higher breast milk HIV-1 RNA during MBF is unlikely.
KeywordsExclusive Mixed PMTCT Breast feeding Vertical HIV transmission
This study was supported in part by a grant from the Belgian Technical Corporation (RR), by NIH grant D43 TW000004 (RR), and by the Fogarty International Clinical Research Scholars and Fellows Program (RR, JEH). We are grateful to the patients who participated in the Mashi study in Botswana. We thank R. Madison, L. Melton, and M. Pretorius Holme for administrative assistance.
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