Incidence of mastitis among breastfeeding HIV-infected women In Malawi: Associations with HIV treatment regimen, breastfeeding status and vertical HIV transmission

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  • March 20, 2019
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  • Zadrozny, Sabrina
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Whether mastitis is associated with HIV transmission among breastfeeding women taking antiretroviral therapy (ART) has important public health implications. We used data from the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study, conducted in Lilongwe, Malawi, to explore the relationship between maternal and infant antiretroviral prophylaxis, breastfeeding behavior, mastitis and HIV transmission. Mother-infant pairs (n = 2369) were randomized to take or not take a nutritional supplement and to one of three treatment groups: maternal antiretroviral therapy (ART), infant nevirapine (NVP) or standard of care. For aim 1, the 28-week risk of mastitis among 1,472 HIV-infected women delivering infants between 2004 and 2007, was higher in the maternal ART (RD 4.5, 95% confidence interval (CI): 0.9, 8.1) and infant NVP (RD: 3.6, 95%CI: 0.9-6.9) groups compared to standard of care. The hazard of late mastitis (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 standard of care. For aims 2 and 3, 1337 HIV-infected women enrolled in BAN between 2004 and 2007, had breastfeeding data and delivered infants HIV-uninfected by 2 weeks. In aim 2, among women with mastitis (n=97, 7%), one (1%, n=1/97) transmitted HIV to her infant and one infant died. Among women without mastitis (n=1240/1337, 93%), 4% (n=52/1240) transmitted HIV to their infants and 7 infants died. For aim 3, we fit a marginal structural discrete time proportional hazards model to estimate the effect of time-varying mastitis or breast inflammation on the duration of exclusive breastfeeding and on the duration of any breastfeeding. The duration of exclusive breastfeeding was longer for women with mastitis compared to those without (HR: 1.07; 95%CI: 0.86, 1.34) and women with mastitis stopped breastfeeding sooner (HR: 0.91; 95%CI: 0.69, 1.21) compared to women without mastitis. The role of mastitis in vertical transmission is a remaining mystery toward eliminating pediatric HIV. Incidence of mastitis and HIV transmission was low, so larger samples or alternate study designs are necessary to investigate the association between mastitis and HIV transmission among breastfeeding women in the era of lifelong ART.
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  • In Copyright
Advisor
  • Pettifor, Audrey
  • Pence, Brian
  • Miller, William
  • Hudgens, Michael
  • Westreich, Daniel
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2016
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