Variation in breastmilk HIV-1 viral load in left and right breasts during the first 3 months of lactation

Willumsen, Juana; Newell, Marie‐Louise; Filteau, Suzanne; Coutsoudis, Anna; Dwarika, Subitha; York, Dennis; Tomkins, Andrew; Coovadia, Hoosen M.

doi:10.1097/00002030-200109280-00026

Cited by 38 publications

(27 citation statements)

References 6 publications

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“…This is consistent with our previously published work as well as that of others (11,12). Higher levels of Ag could not explain the higher frequency of Ag-specific cells, since in the case of HIV infection, breast milk contains much less HIV than plasma (12,17,29). In addition, compared with their counterparts in blood, breast milk CD8 ϩ T cells lack expression of CCR7, CD62L, and CD45RA and express high levels of CD45RO.…”

Section: Discussionsupporting

confidence: 92%

“…We have previously demonstrated that this assay can reproducibly and reliably detect HIV in breast milk (14). In addition, we and others (15)(16)(17) have shown that breast milk RNA levels are at least 10-to 100-fold less than those found in the blood. The breast milk RNA levels in the HIV-infected women in this study were all Ͻ50 copies/ml.…”

Section: Quantitation Of Hiv-1 Rna In Plasma and Breast Milkmentioning

confidence: 67%

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Breast Milk-Derived Antigen-Specific CD8+ T Cells: An Extralymphoid Effector Memory Cell Population in Humans

Sabbaj

Ghosh

Edwards

et al. 2005

The Journal of Immunology

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Although mouse studies have demonstrated the presence of an effector memory population in nonlymphoid tissues, the phenotype of human CD8+ T cells present in such compartments has not been characterized. Because of the relatively large number of CD8+ T cells present in breast milk, we were able to characterize the phenotype of this cell population in HIV-infected and uninfected lactating women. CMV, influenza virus, EBV, and HIV-specific CD8+ T cells as measured by the IFN-γ ELISPOT and MHC class I tetramer staining were all present at greater frequencies in breast milk as compared with blood. Furthermore, a greater percentage of the breast milk CD8+ T cells expressed the intestinal homing receptor, CD103, and the mucosal homing receptor CCR9. Breast milk T cells were predominantly CD45RO+HLADR+ and expressed low levels of CD45RA, CD62L, and CCR7 consistent with an effector memory population. Conversely, T cells derived from blood were mainly characterized as central memory cells (CCR7+CD62L+). These results demonstrate a population of extralymphoid CD8+ T cells with an effector memory phenotype in humans, which could contribute to enhanced local virologic control and the relative lack of HIV transmission via this route.

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Section: Discussionsupporting

confidence: 92%

Section: Quantitation Of Hiv-1 Rna In Plasma and Breast Milkmentioning

confidence: 67%

Breast Milk-Derived Antigen-Specific CD8+ T Cells: An Extralymphoid Effector Memory Cell Population in Humans

Sabbaj

Ghosh

Edwards

et al. 2005

The Journal of Immunology

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“…Rapid transition from exclusive breast milk to full replacement feedings might further decrease the risk of transmission by minimizing the concurrent exposure to nonbreast milk substances and HIV-containing breast milk. It is speculated that pathogen-or allergen-containing foods taken with mixed feeding may increase gut permeability or mucosal inflammation [5], and/or incomplete breast emptying may lead to subclinical mastitis [6] and increased breast milk viral load [7]. Although it is difficult to conceive of other settings where the discomfort and potential harm produced by rapid weaning might have a net benefit, abrupt and complete cessation of exclusive breastfeeding may have an important role in reducing postnatal transmission of HIV.…”

Section: Introductionmentioning

confidence: 99%

Post-weaning breast milk HIV-1 viral load, blood prolactin levels and breast milk volume

Thea

Aldrovandi

Kankasa

et al. 2006

Aids

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“…Interestingly, it has been observed that the cell-free viral load in breast milk at 1, 6 and 14 weeks postpartum varies considerably between the right and left breast of an individual woman at any given time. Breast milk HIV-1 load was undetectable in approximately one third of the samples [7] .…”

Section: Maternal Viral Load and Cd4 Countmentioning

confidence: 98%

HIV and Lactation

Downs

Cooper

2007

Ann Nestlé [Engl]

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It is well established that more than 90% of children with HIV acquired it through mother-to-child transmission (MTCT). It is estimated that 750,000 children worldwide become infected with HIV every year, and most of these are in sub-Saharan Africa. Routes of MTCT include: transplacental during pregnancy, during birth, through breast milk and bleeding nipples. The percent risk of MTCT varies with each of the aforementioned routes. In the absence of specific interventions, the rate of MTCT is approximately 15–20% and, with prolonged breastfeeding (>6 months), the rates double to 35–40%. Although the use of breast milk substitutes (BMS) may appear to be the obvious choice to reduce the risk of MTCT via breast milk and bleeding nipples, this option may prove to be deleterious for infants born to mothers in limited resource settings. In such settings, the high risk of infant mortality is due to severe diarrhea and malnutrition, related to unsafe BMS feeding and suboptimal breastfeeding (that is, failure to exclusively breastfeed for the first 6 months of life). According to a recent WHO report (2006), it is estimated that globally as many as 1.45 million lives (children under 2 years of age) are lost per annum due to suboptimal breastfeeding in developing countries, versus the estimated 242,000 infant deaths related to maternal MTCT. The WHO guidelines for infant feeding in HIV are an important framework of principles that governments, policymakers and health workers need to consider when compiling prevention of MTCT policies and protocols. Both developed and developing countries have communities which do and do not have access to safe water and electricity; hence the policies need to address the needs of different communities. The WHO guidelines advise, ‘when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is acceptable’. Vertically acquired HIV infection has been virtually eliminated in developed countries through the appropriate use of antiretroviral therapy, the use and timing of elective cesarean section, and support for the avoidance of breastfeeding, resulting in a MTCT rate reduction to less than 1–2%.

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Variation in breastmilk HIV-1 viral load in left and right breasts during the first 3 months of lactation

Cited by 38 publications

References 6 publications

Breast Milk-Derived Antigen-Specific CD8+ T Cells: An Extralymphoid Effector Memory Cell Population in Humans

Breast Milk-Derived Antigen-Specific CD8+ T Cells: An Extralymphoid Effector Memory Cell Population in Humans

Post-weaning breast milk HIV-1 viral load, blood prolactin levels and breast milk volume

HIV and Lactation

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