Sabrina Zadrozny1,2, Daniel Westreich2, Michael G Hudgens3, Charles Chasela4, Denise J Jamieson5, Francis Martinson6, Chifundo Zimba6, Gerald Tegha6, Irving Hoffman7, William C Miller8, Brian W Pence2, Caroline C King5, Athena P Kourtis5, Wezi Msungama9, Charles van der Horst6. 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.
RCT Entities:
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), infantnevirapine (NVP) or standard of care for 24 weeks of exclusive breast-feeding and 4 weeks of weaning. Among 1472 HIV-infectedwomen 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 infantnevirapine (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.
Authors: Katherine Semrau; Louise Kuhn; Daniel R Brooks; Howard Cabral; Moses Sinkala; Chipepo Kankasa; Donald M Thea; Grace M Aldrovandi Journal: Am J Obstet Gynecol Date: 2011-06-15 Impact factor: 8.661
Authors: Charles S Chasela; Michael G Hudgens; Denise J Jamieson; Dumbani Kayira; Mina C Hosseinipour; Athena P Kourtis; Francis Martinson; Gerald Tegha; Rodney J Knight; Yusuf I Ahmed; Deborah D Kamwendo; Irving F Hoffman; Sascha R Ellington; Zebrone Kacheche; Alice Soko; Jeffrey B Wiener; Susan A Fiscus; Peter Kazembe; Innocent A Mofolo; Maggie Chigwenembe; Dorothy S Sichali; Charles M van der Horst Journal: N Engl J Med Date: 2010-06-17 Impact factor: 91.245
Authors: Kevin M Lunney; Peter Iliff; Kuda Mutasa; Robert Ntozini; Laurence S Magder; Lawrence H Moulton; Jean H Humphrey Journal: Clin Infect Dis Date: 2010-03-01 Impact factor: 9.079
Authors: Nicole L Davis; William C Miller; Michael G Hudgens; Charles S Chasela; Dorothy Sichali; Dumbani Kayira; Julie A E Nelson; Jeffrey S A Stringer; Sascha R Ellington; Athena P Kourtis; Denise J Jamieson; Charles van der Horst Journal: AIDS Date: 2014-11-28 Impact factor: 4.177
Authors: David Gatsinzi Rutagwera; Jean-Pierre Molès; Chipepo Kankasa; Mwiya Mwiya; Edouard Tuaillon; Marianne Peries; Nicolas Nagot; Philippe Van de Perre; Thorkild Tylleskär Journal: Front Immunol Date: 2022-03-04 Impact factor: 7.561