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Mastitis and Immunological Factors in Breast Milk of Human Immunodeficiency Virus-infected Women

550 N. Broadway, Suite 700, Baltimore, MD 21205 USA.

Newton Kumwenda, PhD

Taha E. Taha, MBBS PhD

Johns Hopkins School of Hygiene and Public Health.

Donald R. Hoover, PhD

Johns Hopkins University.

Thomas C. Quinn, MD

Johns Hopkins School of Medicine and the National Institutes of Health.

Yin Lan, MS

Johns Hopkins.

Laban Mtimavalye, MD

Queen Elizabeth Central Hospital.

Robin Broadhead, FRCP

College of Medicine at the University of Malawi; Department of Paediatrics and Child Health.

Paolo G. Miotti, MD MPH

Office of AIDS Research, National Institutes of Health.

Len van der Hoeven, RN

Queen Elizabeth Central Hospital.

John D. Chiphangwi, FRCOG

College of Medicine at the University of Malawi.

Human milk contains important immunological factors that protect the breast from infection and are thought to protect infants from infection, including human immunodeficiency virus (HIV) infection. Human milk immunological factors have not been well characterized in HIV infected lactating women. Lysozyme, secretory leukocyte protease inhibitor (SLPI), sodium (an indicator of mastitis), and HIV were measured in breast milk of 334 HIV-infected women at 6 weeks postpartum. Women with mastitis, as indicated by elevated breast milk sodium concentrations, had higher median levels lysozyme (290 vs 221 mg/L,p<0.04), SLPI (38 vs 19 mg/L,p<0.0001) and HIV (920 copies/mL vs undetectable,p<0.0001) compared with women without mastitis. Lower total plasma carotenoid levels (p<0.0²) and higher maternal HIV load (p<0.00⁶) by quartile were risk factors for mastitis. Mastitis, as indicated by elevated breast milk sodium levels, is associated with high concentrations of immunological factors and higher HIV load in breast milk.

Key Words: mastitis • lysozyme • secretory leukocyte protease inhibitor • HIV

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