Paediatr Perinat Epidemiol

for the BAN Study Team

Background The relationship between mastitis and antiretroviral therapy among HIV-positive, breastfeeding 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 breastfeeding and 4 weeks of weaning. Among 1,472 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, 88 of 1472 women experienced at least one occurrence of mastitis or breast inflammation. The 28-week risk was higher for 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) 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 breastfeeding 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.

28205255

PMC6029881

Journal Article

Malawi

CDC Public Access