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Paediatr Perinat Epidemiol. 2017 Mar;31(2):134-143. doi: 10.1111/ppe.12337. Epub 2017 Feb 16.

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

Author information

1
Carolina Population Center, Universitiy of North Carolina, Chapel Hill.
2
Department of Epidemiology, University of North Carolina, Chapel Hill.
3
Department of Biostatistics, University of North Carolina, Chapel Hill.
4
University of Witwatersrand, Pretoria, South Africa.
5
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
6
UNC Project, Lilongwe, Malawi.
7
Department of Medicine, University of North Carolina, Chapel Hill.
8
College of Public Health, Division of Epidemiology, The Ohio State University, Columbus, OH.
9
Health Services Branch, Centers for Disease Control Malawi, Lilongwe, Malawi.

Abstract

BACKGROUND:

The relationship between mastitis and antiretroviral therapy among HIV-positive, breast-feeding 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 breast-feeding and 4 weeks of weaning. Among 1472 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, 102 of 1472 women experienced at least one occurrence of mastitis or breast inflammation. The 28-week risk was higher for maternal ART (risk difference (RD) 4.5, 95% confidence interval (CI) 0.9, 8.1) and infant NVP (RD 3.6, 95% CI 0.3, 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 breast-feeding 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.

KEYWORDS:

Mastitis; breast-feeding; human immunodeficiency virus; infant nevirapine; prophylactic antiretroviral therapy

PMID:
28205255
PMCID:
PMC6029881
DOI:
10.1111/ppe.12337
[Indexed for MEDLINE]
Free PMC Article

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