Journal Article

Infant Morbidity, Mortality, and Breast Milk Immunologic Profiles among Breast-Feeding HIV-Infected and HIV-Uninfected Women in Botswana

Shapiro, Roger L., Janoff, Edward N., Stevens, Lisa, Smeaton, Laura, Wester, Carolyn, Arimi, Peter, Ndase, Patrick, Makhema, Joseph, Montano, Monty, Asmelash, Aida, Rahkola, Jeremy T., Lockman, Shahin, Thior, Ibou, Kim, Soyeon, Moffat, Claire, Essex, Max

2007

Overview

Background. Infants of human immunodeficiency virus (HIV)-infected women have high mortality, but the immunologic integrity and protection afforded by the breast milk of HIV-infected women is unknown. Methods. We determined morbidity and mortality by 24 months among breast-fed infants of 588 HIV-infected and 137 HIV-uninfected women followed-up in a clinical trial in Botswana. A matched case-control study compared clinical, behavioral, and breast milk immunologic parameters among 120 HIV-infected women by infant outcome. Breast milk factors were also compared between HIV-infected and HIV-uninfected women. Results. Twenty-four-month mortality was 29.5% among HIV-infected infants, 6.7% among HIV-exposed uninfected infants, and 1.6% among HIV-unexposed infants. No differences were detected in breast milk immunologic profiles of HIV-infected women whose infants were either ill or well. Discontinuation of breast-feeding was the strongest predictor of illness (P < .001). Levels in breast milk of pathogen-specific immunoglobulin (Ig) G and IgA to Haemophilus influenzae, Campylobacter jejuni, Helicobacter pylori, Streptococcus pneumoniae, and innate immune factors were not lower among HIV-infected women than among HIV-uninfected women. Conclusions. Mortality was higher among HIV-infected and HIV-exposed infants than among HIV-unexposed infants. However, the immunologic profiles of breast milk among HIV-infected women were intact, and discontinuation of breast-feeding was the primary risk for infant morbidity. Thus, the breast milk of HIV-infected women may confer protection against common infant pathogens. Trial registration. ClinicalTrials.gov identifiers: NCT00197691 and NCT00197652.

• Publisher: The University of Chicago Press,University of Chicago Press
• Subject: Antibodies, Bacterial - analysis / Antibodies, Bacterial - immunology / Antibody Specificity / Biological and medical sciences / Botswana - epidemiology / Breast Feeding / Breast milk / Campylobacter jejuni - immunology / Case-Control Studies / Child, Preschool / Diarrhea / Diseases / Female / Haemophilus influenzae / Haemophilus influenzae - immunology / Helicobacter pylori / Helicobacter pylori - immunology / HIV / HIV 1 / HIV Infections - epidemiology / HIV Infections - immunology / HIV/AIDS / Human immunodeficiency virus / Human viral diseases / Humans / Immunity, Innate / Immunoglobulin A - analysis / Immunoglobulin G - analysis / Immunoglobulin M - analysis / Immunology / Infant / Infants / Infectious diseases / Medical sciences / Milk, Human - immunology / Milk, Human - microbiology / Morbidity / Mortality / Pregnancy / Risk Factors / Streptococcus pneumoniae / Streptococcus pneumoniae - immunology / Viral diseases / Viral diseases of the lymphoid tissue and the blood. Aids / Women