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Effect of Postnatal HIV Treatment on Clinical Mastitis and Breast Inflammation in HIV ‐Infected Breast‐feeding Women
Author(s) -
Zadrozny Sabrina,
Westreich Daniel,
Hudgens Michael G.,
Chasela Charles,
Jamieson Denise J.,
Martinson Francis,
Zimba Chifundo,
Tegha Gerald,
Hoffman Irving,
Miller William C.,
Pence Brian W.,
King Caroline C.,
Kourtis Athena P.,
Msungama Wezi,
Horst Charles
Publication year - 2017
Publication title -
paediatric and perinatal epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 88
eISSN - 1365-3016
pISSN - 0269-5022
DOI - 10.1111/ppe.12337
Subject(s) - medicine , nevirapine , breastfeeding , mastitis , breast feeding , hazard ratio , weaning , breast milk , obstetrics , confidence interval , pediatrics , human immunodeficiency virus (hiv) , immunology , antiretroviral therapy , viral load , biochemistry , chemistry , pathology
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.