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Journal of Tropical Pediatrics Advance Access originally published online on April 4, 2006
Journal of Tropical Pediatrics 2006 52(5):311-315; doi:10.1093/tropej/fml011
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© The Author [2006]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Effect of Antibiotic Treatment of Subclinical Mastitis on Human Immunodeficiency Virus Type 1 RNA in Human Milk

V. Nussenblatta, N. Kumwendab,c, V. Lemac, T. Quinna, M. C. Nevilled, R. Broadheadc, T. E. Tahab and R. D. Sembaa,

aJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
bJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
cCollege of Medicine, University of Malawi, Blantyre, Malawi
dDepartment of Physiology and Biophysics, University of Colorado School of Health Sciences, Denver, Colorado, USA

Correspondence: Dr Richard D. Semba, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 700, Baltimore, MD 21205, USA. E-mail < rdsemba{at}jhmi.edu>.

Although subclinical mastitis is associated with increased HIV load in breast milk, it is not known whether empirical treatment with antibiotics will reduce breast milk HIV load. We examined the effect of antibiotic treatment for subclinical mastitis on HIV load in breast milk. Seventy-five HIV-infected post-partum women in Malawi with subclinical mastitis were treated with oral amoxicillin/clavulanic acid and were followed between 1 and 24 weeks later. Breastmilk HIV-1 load and sodium concentration were measured and microbiological studies were performed at presentation. At 1 week (n = 34), the proportion of women with elevated breast milk leukocyte counts decreased significantly to 41.2% (p < 0.0001) and there was a nonsignificant increase in breast milk HIV-1 RNA load (p = 0.9264) and sodium concentration (p = 0.08) in the affected breast. At 4 to 12 weeks (n = 63), breast milk HIV-1 RNA load and sodium concentration decreased significantly (p < 0.05) and 17.5% had elevated breast milk leukocyte counts. Treatment with amoxicillin/clavulanic acid was associated with a significant decrease in inflammation of the breast, but breast milk HIV load remained elevated despite a significant decrease from baseline. These findings have important implications regarding how mothers should be counselled on safety of resuming breastfeeding after resolution of subclinical mastitis.


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