DETECTION OF HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 (HIV-1) DNA AND P24 ANTIGEN IN BREAST-MILK OF HIV-1-INFECTED UGANDAN WOMEN AND VERTICAL TRANSMISSION

Objective. To determine the correlation between the detection of human immunodeficiency virus type 1 (HIV-1) in breast milk, the duration of breastfeeding, and vertical transmission of HIV-1 infection in Uganda n women. Methods. A prospective study of HIV-1 infection in pregnant U gandan women and their infants has been ongoing since 1990 with follow -up of mother-infant pairs for at least 2 years. Expressed breast milk specimens were collected from 201 HIV-1-seropositive and 86 HIV-1-ser onegative Ugandan women approximately 6 weeks after delivery. The pres ence of HIV-1 DNA in the cellular fraction of the breast milk was dete cted by polymerase chain reaction (PCR), and HIV-1 p24 antigen was det ected in the cell-free breast milk supernatant using p24 antigen enzym e immunoassay (EIA) after immune complex dissociation (ICD). The durat ion of breastfeeding and the clinical status of the mothers and their children were recorded. HIV-1 EIA, Western blot, PCR, or p24 antigen d etection were used for the determination of the HIV-1 infection status of the children. Results. Of the 201 HIV-1-infected women studied, 47 had HIV-1-infected children, 143 had children who seroreverted, and 1 1 had children of indeterminate status. Breast milk supernatants were available for ICD p24 antigen testing from 188 of the HiV-1-infected w omen and none had detectable p24 antigen. Breast milk cell pellets wer e available and contained amplifiable DNA in 125 of the HIV-1-infected women (20 transmitters, 104 nontransmitters, 1 indeterminate). HIV-1 DNA was detected by PCR in 72% (75/104) of nontransmitters and 80% (16 /20) of the transmitters. The duration of breastfeeding by transmitter mothers (15.8 months) was not significantly different from nontransmi tter mothers (14.4 months). Conclusions. No correlation was found betw een the detection of HIV-1 in breast milk or the duration of breastfee ding and transmission of HIV-1 infection in this study of Ugandan wome n.