Cell-free virus in breast milk of HIV-1-seropositive women

To examine the prevalence, quantification, and factors that influence HIV i n the cell-free compartment of breast milk, we performed reverse transcript ion polymerase chain reaction (RT-PCR) on samples obtained from HIV-1-infec ted study subjects. Virus was detected in 86 of 136 samples (63.2%) from 79 study subjects. HIV RNA quantity ranged from undetectable to 227,586 copie s/ml. Prevalence and mean viral load were not affected by postnatal ages or maternal vitamin A supplementation. Among study subjects with multiple sam ples, breast milk viral load did not change at different postnatal ages. Br east milk viral load correlated positively with plasma viral load (r = 0.47 ; p =.005) and negatively with maternal CD4 count at entry to the study (r = -0.26; p = .02). Mothers of HIV-infected children had a higher proportion of detectable HIV RNA in their breast milli than mothers of uninfected chi ldren (p = .03) and higher mean log(10) HIV RNA quantities (p = .03). In a multivariate logistic regression model, log(10) HIV RNA quantity in breast milk was significantly associated with the risk of mother-child transmissio n (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.22-6.51). Thus, p revention and treatment of opportunistic infections and of mastitis and ear ly weaning may be important elements of a public health policy that is rele vant to women in developing countries with HIV infection. Where available, antiretrovirals may also have an impact on opportunistic infections and mas titis.