Demographic characteristics, clinical diagnosis and laboratory findings of patients enrolled at KDH.

†<p><i>Escherichia coli</i> (1), <i>Enterobacter cloacae</i> (1), <i>Staphylococcus</i> aureus (1).</p>‡<p><i>Acinetobacter baumanii</i> (1), <i>Citrobacter koseri</i> (1), <i>Pseudomonas aeruginosa</i> (2), <i>Staphylococcus aureus</i> (6) <i>Staphylococcus saprophyticus</i> (3), <i>Streptococcus faecalis</i> (1), <i>Streptococcus mitis</i> (1), <i>Streptococcus viridans</i> (2).</p

Nevirapine, Sodium Concentration and HIV-1 RNA in Breast Milk and Plasma among HIV-Infected Women Receiving Short-Course Antiretroviral Prophylaxis

<div><p>Introduction</p><p>Risk factors for breast milk transmission of HIV-1 from mother to child include high plasma and breast milk viral load, low maternal CD4 count and breast pathology such as mastitis.</p><p>Objective</p><p>To determine the impact of nevirapine and subclinical mastitis on HIV-1 RNA in maternal plasma and breast milk after intrapartum single-dose nevirapine combined with either 1-week tail of Combivir (zidovudine/lamivudine) or single-dose Truvada (tenofovir/emtricitabine).</p><p>Methods</p><p>Maternal plasma and bilateral breast milk samples were collected between April 2008 and April 2011 at 1, 4 and 6 weeks postpartum from HIV-infected Tanzanian women. Moreover, plasma samples were collected at delivery from mother and infant.</p><p>Results</p><p>HIV-1 RNA was quantified in 1,212 breast milk samples from 273 women. At delivery, 96% of the women and 99% of the infants had detectable nevirapine in plasma with a median (interquartile range, IQR) of 1.5 μg/mL (0.75–2.20 μg/mL) and 1.04 μg/mL (0.39–1.71 μg/mL), respectively (P < 0.001). At 1 week postpartum, 93% and 98% of the women had detectable nevirapine in plasma and breast milk, with a median (IQR) of 0.13 μg/mL (0.13–0.39 μg/mL) and 0.22 μg/mL (0.13–0.34 μg/mL), respectively. Maternal plasma and breast milk HIV-1 RNA correlated at all visits (R = 0.48, R = 0.7, R = 0.59; all P = 0.01). Subclinical mastitis was detected in 67% of the women at some time during 6 weeks, and in 38% of the breast milk samples. Breast milk samples with subclinical mastitis had significantly higher HIV-1 RNA at 1, 4 and 6 weeks (all P < 0.05).</p><p>Conclusion</p><p>After short-course antiretroviral prophylaxis, nevirapine was detectable in most infant cord blood samples and the concentration in maternal plasma and breast milk was high through week 1 accompanied by suppressed HIV-1 RNA in plasma and breast milk.</p></div

CONSORT Diagram.

<p>The flow chart indicates the number of women included from the ComTru study. The women were allocated to Combivir (zidovudine/lamivudine) or Truvada (tenofovir/emtricitabine) treatment before inclusion in the present study. There were no differences in nevirapine concentration, HIV-1 RNA or sodium concentration between the two trial arms of the ComTru study.</p

Nevirapine Concentration in Infant Cord Blood and Maternal Plasma and Breast Milk from 273 HIV-Infected Women and their Infants.

<p>The medians at delivery are based on 223 maternal plasma samples and 165 infant cord blood samples. The medians at 1 week postpartum are based on 228 maternal plasma samples and 205 breast milk samples. The median at 4 weeks postpartum is based on 42 maternal plasma samples.</p

Mean log₁₀ HIV-1 RNA in Maternal Plasma and Breast Milk from 273 HIV-Infected Women.

<p>Ranges are represented with error bars. The mean at delivery is based on 223 plasma samples. The means at 1 week postpartum are based on 227 plasma samples and 207 breast milk samples. The means at 4 weeks postpartum are based on 228 plasma samples and 198 breast milk samples. The means at 6 weeks postpartum are based on 252 plasma samples and 208 breast milk samples.</p

Characteristics of the 583 newborns included in the FW charts and their mothers.

a<p>) Ethnic groups with less than 2% of the women represented.</p>b<p>) Median.</p>c<p>) BW<2500 g.</p><p>Code: GA = gestational age, G = gram, Kg = kilogram, N = number, SD = standard deviation.</p