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Randomized Controlled Trial
. 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

Sabrina Zadrozny  1   2 , Daniel Westreich  2 , Michael G Hudgens  3 , Charles Chasela  4 , Denise J Jamieson  5 , Francis Martinson  6 , Chifundo Zimba  6 , Gerald Tegha  6 , Irving Hoffman  7 , William C Miller  8 , Brian W Pence  2 , Caroline C King  5 , Athena P Kourtis  5 , Wezi Msungama  9 , Charles van der Horst  6 ; BAN Study Team
Affiliations
Randomized Controlled Trial

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

Sabrina Zadrozny et al. Paediatr Perinat Epidemiol. 2017 Mar.

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.

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Figures

Figure 1
Figure 1
Prevalence of symptoms of breast inflammation in the first 28 weeks after delivery among HIV-infected breastfeeding women in Lilongwe, Malawi *Fewer than five women at any given visit presented with the following symptoms, which were not included in the above figure: Tender Lumps, Tender Axilla Nodes, Nipple Bleeding, Nipple Rash, Nipple Exudates, Breast Sores and Areola Sores
Figure 2
Figure 2
Cumulative incidence estimates for mastitis or breast inflammation, comparing 2a) maternal ART, infant NVP and standard of care and 2b) nutritional supplement versus no nutritional supplement
See this image and copyright information in PMC

References

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