Infective and anti-infective properties of breastmilk from HIV-1-infected women

Lancet. 1993 Apr 10;341(8850):914-8. doi: 10.1016/0140-6736(93)91210-d.


Human immunodeficiency virus type 1 (HIV-1) is transmitted mainly by cell-to-cell contact. We postulated that transmission of HIV-1 through breastmilk could be favoured by the presence of infected cells, by deficiency of anti-infective substances in breastmilk, or both factors. 215 HIV-1-infected women were enrolled at delivery in Kigali, Rwanda; milk samples were collected 15 days, 6 months, and 18 months post partum. HIV-1 IgG, secretory IgA, and IgM were assayed by western blot, for the latter two after removal of IgG with protein G. In the 15-day and 6-month samples, we sought viral genome in milk cells by a double polymerase chain reaction with three sets of primers (gag, pol, and env). HIV-1 infection in the offspring was defined according to serological and clinical criteria. At 15 days, 6 months, and 18 months post partum, HIV-1 specific IgG was detected in 95%, 98%, and 97% of breastmilk samples, IgA in 23%, 28%, and 41%, and IgM in 66%, 78%, and 41%. In children who survived longer than 18 months, the probability of infection was associated with lack of persistence of IgM and IgA in their mothers' milk (adjusted chi 2 for trend, p = 0.01 for IgM and p = 0.05 for IgA). The presence of HIV-1-infected cells in the milk 15 days post partum was strongly predictive of HIV-1 infection in the child, by both univariate (p < 0.05) and multivariate analysis (p = 0.01). The combination of HIV-1-infected cells in breastmilk and a defective IgM response was the strongest predictor of infection. HIV-1 infection in breastfed children born to infected mothers is associated with the presence of integrated viral DNA in the mothers' milk cells. IgM and IgA anti-HIV-1 in breastmilk may protect against postnatal transmission of the virus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analysis of Variance
  • Blotting, Western
  • Breast Feeding*
  • CD4-CD8 Ratio
  • DNA, Viral / chemistry
  • Female
  • HIV Antibodies / chemistry
  • HIV Infections / epidemiology
  • HIV Infections / immunology
  • HIV Infections / transmission*
  • HIV-1* / immunology
  • Humans
  • Immunoglobulin A, Secretory / chemistry
  • Immunoglobulin G / chemistry
  • Immunoglobulin M / chemistry
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Milk, Human / chemistry
  • Milk, Human / immunology
  • Milk, Human / microbiology*
  • Multivariate Analysis
  • Nerve Tissue Proteins
  • Odds Ratio
  • Polymerase Chain Reaction
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors
  • Rwanda / epidemiology
  • Survival Rate
  • Time Factors


  • DNA, Viral
  • G-substrate
  • HIV Antibodies
  • Immunoglobulin A, Secretory
  • Immunoglobulin G
  • Immunoglobulin M
  • Nerve Tissue Proteins