Role of Intestinal Mucosal Integrity in HIV Transmission to Infants through Breast-feeding: The BAN Study

Citation

Kourtis, Athena P.; Ibegbu, Chris C.; Wiener, Jeffrey B.; King, Caroline C.; Tegha, Gerald; Kamwendo, Deborah D.; Kumwenda, Jacob; Kaur, Surinder P.; Flax, Valerie L.; & Ellington, Sascha R., et al. (2013). Role of Intestinal Mucosal Integrity in HIV Transmission to Infants through Breast-feeding: The BAN Study. Journal of Infectious Diseases, 208(4), 653-661. PMCID: PMC3719904

Abstract

Background: Increased intestinal permeability may be one of the mechanisms of transmission of human immunodeficiency virus (HIV) to infants through breast-feeding. Intestinal permeability correlates with microbial translocation, which can be measured through quantification of bacterial lipopolysaccharide (LPS).
Methods: We evaluated levels of plasma LPS (by the Limulus amebocyte lysate assay) and immune activation markers in serial specimens from infants exposed to but uninfected with HIV and infants infected with HIV from the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study.
Results: Plasma LPS levels increased after infants in the BAN study were weaned from the breast, at 24 weeks of age. Cotrimoxazole prophylaxis was associated with higher plasma LPS levels (P = .004). Infants with HIV infection had higher LPS levels, compared with uninfected infants (P = .004). Higher preinfection plasma LPS levels were a significant predictor of infant HIV infection through breast-feeding (hazard ratio = 1.60 for every unit increase in plasma LPS level; P = .01) and of lower infant length-for-age z scores (P = .02).
Conclusions: These findings suggest that disruption in intestinal integrity is a mechanism of HIV transmission to infants through breast-feeding. Weaning from breast milk and use of antibiotic prophylaxis was associated with increased levels of microbial translocation, which could facilitate HIV entry through the intestine. Complementary approaches to enhance intestinal mucosal integrity in the infant may further reduce breast-feeding transmission of HIV.

URL

http://dx.doi.org/10.1093/infdis/jit221

Reference Type

Journal Article

Year Published

2013

Journal Title

Journal of Infectious Diseases

Author(s)

Kourtis, Athena P.
Ibegbu, Chris C.
Wiener, Jeffrey B.
King, Caroline C.
Tegha, Gerald
Kamwendo, Deborah D.
Kumwenda, Jacob
Kaur, Surinder P.
Flax, Valerie L.
Ellington, Sascha R.
Kacheche, Zebrone
Kayira, Dumbani
Chasela, Charles S.
van der Horst, Charles M.
Jamieson, Denise J.

PMCID

PMC3719904

ORCiD

Flax - 0000-0003-0200-3355