Cytomegalovirus and Epstein-Barr virus in breast milk are associated with HIV-1 shedding but not with mastitis

• Published in: AIDS (London) Vol. 22; no. 12; pp. 1453 - 1460
• Main Authors: GANTT, Soren, CARLSSON, Jacquelyn, FRENKEL, Lisa M, SHETTY, Avinash K, SEIDEL, Kristy D, XUAN QIN, MUTSVANGWA, Junior, MUSINGWINI, Georgina, WOELK, Godfrey, ZIJENAH, Lynn S, KATZENSTEIN, David A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 31.07.2008
• Subjects: AIDS-Related Opportunistic Infections - complications; AIDS/HIV; Biological and medical sciences; Breast Feeding; Cross-Sectional Studies; Cytomegalovirus; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - complications; DNA, Viral - analysis; Epstein-Barr virus; Epstein-Barr Virus Infections - complications; Female; Gynecology. Andrology. Obstetrics; Herpesvirus; Herpesvirus 4, Human - isolation & purification; HIV Infections - complications; HIV Infections - transmission; HIV-1 - genetics; HIV-1 - isolation & purification; Human cytomegalovirus; Human herpesvirus 7; Human herpesvirus 8; Human immunodeficiency virus 1; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious Disease Transmission, Vertical; Infectious diseases; Mammary gland diseases; Mastitis - virology; Medical sciences; Milk, Human - virology; Mycoplasma; Non tumoral diseases; RNA, Viral - analysis; Specimen Handling - methods; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; HIV-1 virus; Epstein Barr virus; Maternal diseases; Betaherpesvirinae; mycobacteria; Human cytomegalovirus; Mollicutes; Mycoplasmatales; Human herpesvirus 8; Human herpesvirus 7; cytomegalovirus; HHV-7; Bacteria; HHV-8; Epstein-Barr virus; mycoplasmas; Human herpesvirus 6; Gammaherpesvirinae; Immunopathology; Mycobacterium; Mastitis; Herpesviridae; HHV-6; Retroviridae; AIDS; mother-to-child-transmission; Breast feeding; Mycoplasma; Immune deficiency; Lentivirus; Mycoplasmataceae; Infection; Virus; Mammary gland diseases; Mycobacteriales; Viral disease; Mycobacteriaceae; Human milk; Vertical transmission; Actinomycetes; Human immunodeficiency virus; breastfeeding; Breast milk
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0b013e32830184f2

Breast milk HIV-1 load is associated with clinical and subclinical mastitis, and both milk viral load and mastitis are associated with increased mother-to-child-transmission of HIV-1 through breastfeeding. Bacterial infections may cause clinical mastitis, but whether other copathogens common in HIV-1 infection are associated with subclinical mastitis or HIV-1 shedding is unknown. A cross-sectional study of HIV-1-infected breastfeeding women in Zimbabwe was performed to examine the relationship between a wide range of breast coinfections, mastitis, and HIV-1 shedding. Breast milk was cultured for bacteria and fungi and tested by PCR for mycobacteria, mycoplasmas, human herpesvirus (HHV)-6, HHV-7, HHV-8, cytomegalovirus, Epstein-Barr virus, and HIV-1 RNA and DNA. Symptoms of clinical mastitis were documented and subclinical mastitis was identified by breast milk sodium concentration (Na) and leukocyte counts. Coinfections of milk were not associated with clinical or subclinical mastitis in the 217 women studied. Detection of HIV-1 RNA, but not DNA, in breast milk was associated with cytomegalovirus concentration (odds ratio = 1.8, P = 0.002) and detection of Epstein-Barr virus (odds ratio = 3.8, P = 0.0003) but not other coinfections in multivariate analysis. Coinfection of breast milk with bacteria, fungi, or herpes viruses was not associated with mastitis. The associations between shedding of cytomegalovirus and Epstein-Barr virus with HIV-1 in milk suggest a local interaction between herpes virus infection and HIV-1 independent of mastitis. Cytomegalovirus and Epstein-Barr virus infections may impact HIV-1 shedding in breast milk and the risk of MTCT.