Low and undetectable breast milk interleukin-7 concentrations are associated with reduced risk of postnatal HIV transmission

OBJECTIVE: To investigate if breast milk interleukin [IL]-7 concentrations are associated with postnatal HIV transmission. DESIGN: A case-control study nested within a cohort of women recruited in Lusaka, Zambia. METHODS: IL-7 breast milk concentrations were measured in samples from 24 HIV-infected breast-feeding women who transmitted HIV to their child after the neonatal period and from 47 women who did not transmit. Samples were frequency-matched by the time of sample collection (1 week and 1 month postpartum). Logistic regression was used to adjust for possible confounders. For comparison, samples from 18 HIV-uninfected women from the same community were included in the analysis, and plasma IL-7 was determined. RESULTS: Breast milk IL-7 concentrations were significantly higher than plasma IL-7 concentrations in all 3 groups. In contrast to levels among transmitters and HIV-uninfected women, breast milk IL-7 concentrations exhibited a bimodal distribution among nontransmitters. Breast milk IL-7 concentrations undetectable or less than 30 pg/mL were significantly associated with less HIV transmission (odds ratio = 0.13, 95% confidence interval: 0.03 to 0.64). The association remained strong after adjustment for breast milk viral load and sodium, maternal CD4 cell counts, parity, and time of sample collection. CONCLUSION: Breast milk IL-7 may be necessary for effective HIV transmission.