HIV-1 persists in breast milk cells despite antiretroviral treatment to prevent mother-to-child transmission
Date
2008Author
Lehman, Dara A.
Chung, Michael H.
Stewart, Grace C. John
Richardson, Barbra A.
Kiarie, James
Kinuthia, John
Overbaugh, Julie
Type
ArticleLanguage
enMetadata
Show full item recordAbstract
Background: The effects of short-course antiretrovirals given to reduce mother-to-child
transmission (MTCT) on temporal patterns of cell-associated HIV-1 RNA and DNA in
breast milk are not well defined.
Methods: Women in Kenya received short-course zidovudine (ZDV), single-dose
nevirapine (sdNVP), combination ZDV/sdNVP or short-course highly active antiretroviral
therapy (HAART). Breast milk samples were collected two to three times
weekly for 4–6weeks.HIV-1 DNA was quantified b yreal-time PCR.Cell-free and cell associated
RNA levels were quantified by the Gen-Probe HIV-1 viral load assay.
Results: Cell-free HIV-1 RNA levels in breast milk were significantly suppressed by
sdNVP, ZDV/sdNVP or HAART therapy compared with ZDV between day 3 and
week 4 postpartum (P0.03). Breast milk HIV-1 DNA levels (infected cell levels)
were not significantly different between treatment arms at any timepoint during the
4–6-week follow-up. At 3 weeks postpartum, when the difference in cell-free RNA
levels was the greatest comparing HAARTdirectly with ZDV(P¼0.0001),medianlog10
HIV-1 DNA copies per 1106 cells were 2.78, 2.54, 2.69, and 2.31 in the ZDV,
sdNVP, ZDV/sdNVP and HAART arms, respectively (P¼0.23). Cell-associated HIV-1
RNA levels were modestly suppressed in HAART versus ZDV/sdNVP during week 3
(3.37 versus 4.02, P¼0.04), as well as over time according to a linear mixed-effects
model.
Conclusion: Cell-free and,to a lesser extent,cell-associated HIV-1 RNA levels in breast
milk were suppressed by antiretroviral regimens used to prevent MTCT.However,even
with HAART, there was no significant reduction in the reservoir of infected cells,which
could contribute to breast milk HIV-1 transmission.
URI
http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/10359http://www.ncbi.nlm.nih.gov/pubmed/18614871
Citation
AIDS 2008, 22:1475–1485Collections
- Faculty of Health Sciences (FHS) [10387]