Effect of Postnatal HIV Treatment on Clinical Mastitis and Breast Inflammation in HIV‐Infected Breast‐feeding Women

Abstract

Background The relationship between mastitis and antiretroviral therapy among HIV-positive, breastfeeding women is unclear. Methods In the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study, conducted in Lilongwe, Malawi, 2369 mother-infant pairs were randomized to a nutritional supplement group and to one of three treatment groups: maternal antiretroviral therapy (ART), infant nevirapine (NVP) or standard of care for 24 weeks of exclusive breastfeeding and 4 weeks of weaning. Among 1,472 HIV-infected women who delivered live infants between 2004 and 2007, we estimated cumulative incidence functions and sub-distribution hazard ratios (HR) of mastitis or breast inflammation comparing women in maternal ART (n=487) or infant nevirapine (n=492) groups to the standard of care (n=493). Nutritional supplement groups (743 took, 729 did not) were also compared. Results Through 28-weeks post-partum, 88 of 1472 women experienced at least one occurrence of mastitis or breast inflammation. The 28-week risk was higher for maternal ART (RD 4.5, 95% confidence interval (CI): 0.9, 8.1) and infant NVP (RD: 3.6, 95%CI: 0.9-6.9) compared to standard of care. The hazard of late-appearing mastitis or breast inflammation (from week 5-28) was also higher for maternal ART (HR: 6.7, 95%CI: 2.0, 22.6) and infant NVP (HR: 5.1, 95%CI: 1.5, 17. 5) compared to the standard of care. Conclusions Mastitis or breast inflammation while breastfeeding is a possible side effect for women taking prophylactic ART and women whose infants take NVP, warranting additional research in the context of postnatal HIV transmission.

Human immunodeficiency virus‐positive women's perspectives on breastfeeding with antiretrovirals: A qualitative evidence synthesis

“…Various antiretroviral regimens (Option A, B and B+see Table 1) exist for HIV-positive women to breastfeed. HIV MTCT risk may also be elicited by breast infections, such as mastitis and cracked nipples (Zadrozny et al, 2017). Mixed feeding is the introduction of solids and other liquids with breast milk before the age of 6 months (WHO & UNICEF, 2016).…”

Recurrent Severe Subclinical Mastitis and the Risk of HIV Transmission Through Breastfeeding

“…Therefore, factors other than breastfeeding practices and milk removal may be contributing to SCM. Indeed stress (47), depression (7), micronutrient deficiency (35), vitamin E supplementation (13), general maternal health status (25), bacterial infection in the breast (14,48) viral shedding in breast milk (49,50), infant ART prophylaxis (51), and systemic inflammation (3) have all been associated with SCM. Despite high incidence of severe SCM, however, breast health problems were very rare with only 1 mother reporting breast health problems (at week 14) between week 14 and week 38 implying that most of the severe SCM cases resolved spontaneously without presenting any symptoms and consequently without affecting breastfeeding.…”

Comparative effects of three methods of promoting breastfeeding among human immunodeficiency virus–infected women in Uganda: a parallel randomized clinical trial

“…Existing evidence on the side effects of HIV treatment among infants born to HIV-infected mothers suggests daily NVP in an infant's saliva may irritate a mother's nipple. 34 Additionally, other side effects such as oral lesions, conjunctivitis and blistering may contribute to the risk of early EBF cessation due to their influence on quality and frequency of breastfeeding. 35 Further, because both Option A (includes AZT) and Option B+ HIV treatment regimens require NVP for 4-6 weeks or until BF cessation, it is unclear why EBF cessation would be different between these treatment groups.…”