Breastfeeding and Transmission of HIV-1: Epidemiology and Global Magnitude

  • Mary Glenn Fowler
  • Athena P. Kourtis
  • Jim Aizire
  • Carolyne Onyango-Makumbi
  • Marc Bulterys


Over the past two decades, major strides have been made in HIV-1 research and prevention. Among these advances, some of the most remarkable and sustained achievements have been in reducing the risk of transmission of HIV-1 from mothers to their infants. In resource-rich settings such as the USA and Europe, mother-to-child transmission (MTCT) of HIV-1 has successfully been reduced to less than 1–2% [1] with the goal of virtual elimination of new cases. This success in prevention of mother-to-child transmission (PMTCT) of HIV-1 has been achieved by widespread implementation of effective PMTCT antiretroviral therapy (ART) regimens, and obstetrical interventions as well as avoidance of breastfeeding through the use of infant formula.


  1. 1.
    Cooper ER, Charurat M, Mofenson LM et al (2002) Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr Hum Retrovirol 29:484–94Google Scholar
  2. 2.
    Global report: UNAIDS report on the global AIDS epidemic 2010. Accessed Dec 2010
  3. 3.
    DeCock KM, Fowler MG, Mercier E et al (2000) Prevention of mother-to-child HIV-1 transmission in resource-poor countries: translating research into policy and practice. JAMA 283:1175–1182CrossRefGoogle Scholar
  4. 4.
    Townsend CL, Cortina-Borja M, Peckham CS et al (2008) Low rates of MTCT of HIV-1 following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS 22:973–81CrossRefPubMedGoogle Scholar
  5. 5.
    Zhou Z, Meyers K, Li X et al (2010) Prevention of mother-to-child transmission of HIV-1 using highly active antiretroviral therapy in rural Yunnan, China. J Acquir Immune Defic Syndr 53:S15–22CrossRefPubMedGoogle Scholar
  6. 6.
    Mofenson LM (2010) Prevention in neglected subpopulations: prevention of mother-to-child transmission of HIV-1 infection. Clin Infect Dis 50:130–48CrossRefGoogle Scholar
  7. 7.
    Bulterys M, Wilfert CM (2009) HAART during pregnancy and during breast feeding among HIV-1-infected women in the developing world: has the time come? AIDS 23:2473–7CrossRefPubMedGoogle Scholar
  8. 8.
    Kourtis AP, Duerr A (2003) Prevention of perinatal HIV-1 transmission: a review of novel strategies. Expert Opin Investig Drugs 12:1–10CrossRefGoogle Scholar
  9. 9.
    Kuhn L, Reitz C, Abrams EJ (2009) Breastfeeding and AIDS in the developing world. Curr Opin Pediatr 21:83–93CrossRefPubMedGoogle Scholar
  10. 10.
    Newell ML (2006) Current issues in the prevention of mother to child transmission of HIV-1 infection. Trans R Soc Trop Med Hyg 100:1–5CrossRefPubMedGoogle Scholar
  11. 11.
    Mmiro FA, Aizire J, Mwatha AK, Eshleman SH, Donnell D, Fowler MG et al (2009) Predictors of early and late mother-to-child transmission of HIV-1 in a breastfeeding population: HIV-1 network for prevention trials 012 experience, Kampala, Uganda. J Acquir Immune Defic Syndr 52:32–9CrossRefPubMedGoogle Scholar
  12. 12.
    Nduati R, John G, Mbori-Ngacha D et al (2000) Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial. JAMA 283:1167–1174CrossRefPubMedGoogle Scholar
  13. 13.
    Jamieson DJ, Sibailly TS, Sadek R et al (2003) HIV-1 viral load and other risk factors for mother-to-child transmission of HIV-1 in a breast-feeding population in Côte d’Ivoire. J Acquir Immune Defic Syndr 34:430–436CrossRefPubMedGoogle Scholar
  14. 14.
    Koulinska IN, Villamor E, Msamanga G et al (2006) Risk of HIV-1 transmission by breastfeeding among mothers infected with recombinant and non-recombinant HIV-1 genotypes. Virus Res 120:191–8CrossRefPubMedGoogle Scholar
  15. 15.
    Rousseau CM, Nduati RW, Richardson BA et al (2003) Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease. J Infect Dis 187:741–7CrossRefPubMedGoogle Scholar
  16. 16.
    Rousseau CM, Nduati RW, Richardson BA et al (2004) Association of levels of HIV-1 infected breast milk cells and risk of mother-to-child transmission. J Infect Dis 190:1880–8CrossRefPubMedGoogle Scholar
  17. 17.
    The Breastfeeding and HIV International Transmission Study Group (2004) Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis. J Infect Dis 189:2154–66CrossRefGoogle Scholar
  18. 18.
    Bulterys M, Chao A, Dushimimana A, Saah A (1995) HIV-1 seroconversion after 20 months of age in a cohort of breastfed children born to HIV-1-infected women in Rwanda. AIDS 9:93–94PubMedGoogle Scholar
  19. 19.
    Dunn DT, Newell M-L, Ades AE, Peckham CS (1992) Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet 340:585–8CrossRefPubMedGoogle Scholar
  20. 20.
    Van de Perre P, Simonon A, Msellati P, Hitimana DG, Vaira D, Bazubagira A et al (1991) Postnatal transmission of human immunodeficiency virus type 1 from mother to infant. A prospective cohort study in Kigali, Rwanda. N Engl J Med 325:593–8CrossRefPubMedGoogle Scholar
  21. 21.
    Humphrey JH, Marinda E, Mutasa K, Moulton LH, Iliff PJ, Ntozini R et al (2010) Mother to child transmission of HIV-1 among Zimbabwean women who seroconverted postnatally: prospective cohort study. Br Med J 341:c6580CrossRefGoogle Scholar
  22. 22.
    Liang K, Gui X-E, Zhang YZ, Zhuang K, Meyers K, Ho DD (2009) A case series of 104 women infected by HIV-1 via blood transfusion postnatally: high rate of HIV-1 transmission to infants through breastfeeding. J Infect Dis 200:682–6CrossRefPubMedGoogle Scholar
  23. 23.
    Lewis P, Nduati R, Kreiss JK et al (1998) Cell-free human immunodeficiency virus type 1 in breast milk. J Infect Dis 177:34–9CrossRefPubMedGoogle Scholar
  24. 24.
    Gray RR, Salemi M, Lowe A et al (2011) Multiple independent lineages of HIV-1 persist in breast milk and plasma. AIDS 25:143–152CrossRefPubMedGoogle Scholar
  25. 25.
    Eshleman SH, Becker-Pergola G, Deseyve M et al (2001) Impact of human immunodeficiency virus type1 (HIV-1) subtype on women receiving single-dose nevirapine prophylaxis to prevent HIV-1 vertical transmission (HIVNET 012 trial). J Infect Dis 184:914–917CrossRefPubMedGoogle Scholar
  26. 26.
    Bjorndal A, Sonnerborg A, Tscherning C et al (1999) Phenotypic characteristics of human immunodeficiency virus type 1 subtype C isolates of Ethiopian AIDS patients. AIDS 15:647–53Google Scholar
  27. 27.
    Renjifo B, Gilbert P, Chaplin B et al (2004) Preferential in utero transmission of HIV-1 subtype C compared to subtype A or D. AIDS 18:1629–36CrossRefPubMedGoogle Scholar
  28. 28.
    Koulinska IN, Villamor E, Chaplin B et al (2006) Transmission of cell-free and cell-associated HIV-1 through breast-feeding. J Acquir Immune Defic Syndr 41:93–9CrossRefPubMedGoogle Scholar
  29. 29.
    Yang C, Li M, Newman RD et al (2003) Genetic diversity of HIV-1 in western Kenya: subtype-specific differences in mother-to-child transmission. AIDS 11:1667–74CrossRefGoogle Scholar
  30. 30.
    Embree JE, Njenga S, Datta P et al (2000) Risk factors for postnatal mother-child transmission of HIV-1. AIDS 14:2535–41CrossRefPubMedGoogle Scholar
  31. 31.
    Semba RD, Kumwenda N, Hoover DR et al (1999) Human immunodeficiency virus load in breast milk, mastitis, and mother-to-child transmission of human immunodeficiency virus type 1. J Infect Dis 180:93–8CrossRefPubMedGoogle Scholar
  32. 32.
    Kumwenda N, Miotti PG, Taha TE et al (2002) Antenatal vitamin A supplementation increases birth weight and decreases anemia among infants born to human immunodeficiency virus-infected women in Malawi. Clin Infect Dis 35:618–24CrossRefPubMedGoogle Scholar
  33. 33.
    Phiri W, Kasonka L, Collin S et al (2006) Factors influencing breast milk HIV-1 RNA viral load among Zambian women. AIDS Res Hum Retroviruses 22:607–14CrossRefPubMedGoogle Scholar
  34. 34.
    Kupka R, Garland M, Msamanga G et al (2005) Selenium status, pregnancy outcomes, and mother-to-child transmission of HIV-1. J Acquir Immune Defic Syndr 29:201–10Google Scholar
  35. 35.
    Mehta S, Hunter DJ, Mugusi FM et al (2009) Perinatal outcomes, including mother-to-child transmission of HIV-1, and child mortality and their association with maternal vitamin D status in Tanzania. J Infect Dis 200: 1022–30CrossRefPubMedGoogle Scholar
  36. 36.
    Semba RD, Miotti P, Chiphangwi J et al (1994) Maternal vitamin A deficiency and mother-to-child transmission of HIV-1. Lancet 343:1593–7CrossRefPubMedGoogle Scholar
  37. 37.
    Coutsoudis A, Pillay K, Spooner E et al (1999) Randomized trial testing the effect of vitamin A supplementation on pregnancy outcomes and early mother-to-child transmission in Durban, South Africa. AIDS 13:1517–24CrossRefPubMedGoogle Scholar
  38. 38.
    Fawzi W, Msamanga G, Hunter D et al (2002) Randomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality. AIDS 16:1935–44CrossRefPubMedGoogle Scholar
  39. 39.
    Kuhn L (2010) Milk mysteries: why are women who exclusively breastfeed less likely to transmit HIV-1 during breastfeeding? Clin Infect Dis 50:770–2CrossRefPubMedGoogle Scholar
  40. 40.
    Requena M, Bouhlal H, Nasreddine N et al (2008) Inhibition of HIV-1 transmission in trans from dendritic cells to CD4+ by natural antibodies to the CRD domain of DC-SIGN purified from breast milk and intravenous immunoglobulins. Immunology 123:508–18CrossRefPubMedGoogle Scholar
  41. 41.
    Kafulafula G, Hoover DR, Taha TE et al (2010) Frequency of gastroenteritis and gastroenteritis-associated mortality with early weaning in HIV-1-uninfected children born to HIV-1-infected women in Malawi. J Acquir Immune Defic Syndr 53:6–13CrossRefPubMedGoogle Scholar
  42. 42.
    Kuhn L, Sinkala M, Semrau K et al (2010) Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-1 infected mothers. Clin Infect Dis 50:437–44CrossRefPubMedGoogle Scholar
  43. 43.
    Onyango-Makumbi C, Bagenda D, Mwatha A et al (2010) Early weaning of HIV-1 exposed uninfected infants and risk of serious gastroenteritis: findings from two perinatal HIV-1 prevention trials in Kampala, Uganda. J Acquir Immune Defic Syndr 53:20–7CrossRefGoogle Scholar
  44. 44.
    Thea DM, Aldrovandi G, Kankasa C et al (2006) Post-weaning breast milk HIV-1 viral load, blood prolactin levels and breast milk volume. AIDS 20:1539–47CrossRefPubMedGoogle Scholar
  45. 45.
    World Health Organization (2010) Antiretroviral drugs for treating pregnant women and preventing HIV-1 infection in infants: towards universal access. Recommendations for a public health approach (2010 version). Accessed Mar 2011
  46. 46.
    Winchester R, Pitt J, Charurat M et al (2004) Mother- to- child transmission of HIV-1 strong association with certain maternal HLA-B alleles independent of viral load implicates innate immune mechanism. J Acquir immune Defic Syndr 36:639–70CrossRefGoogle Scholar
  47. 47.
    Mackelprang RD, John-Stewart G, Carrington M et al (2008) Maternal HLA homozygosity and mother-child HLA concordance increase the risk of vertical transmission of HIV-1. J Infect Dis 197:1156–1161CrossRefPubMedGoogle Scholar
  48. 48.
    Belyakov IM, Berzofsky JA (2004) Immunobiology of mucosal HIV-1 infection and the basis for development of a new generation of mucosal AIDS vaccines. Immunity 20:247–53CrossRefPubMedGoogle Scholar
  49. 49.
    Iliff PJ, Piwoz EG, Tavengwa NV et al (2005) Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-1-free survival. AIDS 19:699–708CrossRefPubMedGoogle Scholar
  50. 50.
    Kourtis AP, Bulterys M, Nesheim S et al (2001) Understanding the timing of HIV-1 transmission from mother to infant. JAMA 285:709–12CrossRefPubMedGoogle Scholar
  51. 51.
    Kourtis AP, Lee FK, Jamieson DJ et al (2006) Mother-to-child transmission of HIV-1: timing and implications for prevention. Lancet Infect Dis 6:726–32CrossRefPubMedGoogle Scholar
  52. 52.
    Bryson YY, Luzuriaga K, Sullivan JL et al (1992) Proposed definitions for in utero versus intrapartum transmission of HIV-1. N Engl J Med 327:1246–7CrossRefPubMedGoogle Scholar
  53. 53.
    John GC, Nduati R, Mbori-Ngacha DA et al (2001) Correlates of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission: association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA shedding, and breast infections. J Infect Dis 183:206–212CrossRefPubMedGoogle Scholar
  54. 54.
    Lohman-Payne B, Slyker J, Rowland-Jones SL (2010) Immune-based approaches to the prevention of mother-to-child transmission of HIV-1: active and passive immunization. Clin Perinat 37:787–805CrossRefGoogle Scholar
  55. 55.
    Toniolo A, Serra C, Conaldi PG, Basolo F, Falcone V, Dolei A (1995) Productive HIV-1 infection of normal human mammary epithelial cells. AIDS 9:859–866CrossRefPubMedGoogle Scholar
  56. 56.
    Dorosko SM, Connor RI. Primary human mammary epithelial cells endocytose HIV-1 and facilitate viral infection of CD4+ T lymphocytes. J Virol 84:10533–10542Google Scholar
  57. 57.
    Lyimo MA, Howell AL, Balandya E, Eszterhas SK, Connor RI (2009) Innate factors in human breast milk inhibit cell-free HIV-1 but not cell-associated HIV-1 infection of CD4+ cells. J Acquir Immune Defic Syndr 51:117–24CrossRefPubMedGoogle Scholar
  58. 58.
    Bulek K, Swaidani S, Aronica M, Li X (2010) Epithelium: the interplay between innate and Th2 immunity. Immunol Cell Biol 88:257–68CrossRefPubMedGoogle Scholar
  59. 59.
    Kalish LA, Pitt J, Lewis J et al (1997) Defining the time of fetal or perinatal acquisition of HIV-1 infection on the basis of age at first positive culture. J Infect Dis 175:712–5CrossRefPubMedGoogle Scholar
  60. 60.
    Lunney KM, Iliff P, Mutasa K et al (2010) Associations between breast milk viral load, mastitis, exclusive breast-feeding, and postnatal transmission of HIV-1. Clin Infect Dis 50:762–769PubMedGoogle Scholar
  61. 61.
    Willumsen JF, Filteau SM, Coutsoudis A et al (2003) Breastmilk RNA viral load in HIV-1-infected South African women: effects of subclinical mastitis and infant feeding. AIDS 17:407–414CrossRefPubMedGoogle Scholar
  62. 62.
    Hartmann SU, Berlin CM, Howett MK (2006) Alternative modified infant-feeding practices to prevent postnatal transmission of human immunodeficiency virus type 1 through breast milk: past, present, and future. J Hum Lact 22:75–88CrossRefPubMedGoogle Scholar
  63. 63.
    Lehman DA, Farquhar C (2007) Biological mechanisms of vertical human immunodeficiency virus (HIV-1) transmission. Rev Med Virol 17:381–403CrossRefPubMedGoogle Scholar
  64. 64.
    Giuliano M, Guidotti G, Andreotti M et al (2007) Triple antiretroviral prophylaxis administered during pregnancy and after delivery significantly reduces breast milk viral load: a study within the Drug Resource Enhancement Against AIDS and Malnutrition Program. J Acquir Immune Defic Syndr 44:286–291CrossRefPubMedGoogle Scholar
  65. 65.
    Shapiro RL, Ndung’u T, Lockman S, Shapiro RL et al (2005) Highly active antiretroviral therapy started during pregnancy or postpartum suppresses HIV-1 RNA, but not DNA, in breast milk. J Infect Dis 192:713–719CrossRefPubMedGoogle Scholar
  66. 66.
    Farquhar C, VanCott TC, Mbori-Ngacha DA et al (2002) Salivary secretory leukocyte protease inhibitor is associated with reduced transmission of human immunodeficiency virus type 1 through breast milk. J Infect Dis 186:1173–1176CrossRefPubMedGoogle Scholar
  67. 67.
    Baron S, Poast J, Richardson CJ et al (2000) Oral transmission of HIV-1 by infected seminal fluid and milk: a novel mechanism. J Infect Dis 181:498–504CrossRefPubMedGoogle Scholar
  68. 68.
    Shugars DC (1999) Endogenous mucosal antiviral factors of the oral cavity. J Infect Dis 179:S431–5CrossRefPubMedGoogle Scholar
  69. 69.
    Villamor E, Koulinska IN, Furtado J et al (2007) Long-chain n-6 polyunsaturated fatty acids in breast milk decrease the risk of HIV-1 transmission through breastfeeding. Am J Clin Nutr 86:682–9PubMedGoogle Scholar
  70. 70.
    Becquart P, Hocini H, Levy M, Sepou A, Kazatchkine MD, Belec L (2000) Secretory anti-human immunodeficiency virus (HIV-1) antibodies in colostrum and breast milk are not a major determinant of the protection of early postnatal transmission of HIV-1. J Infect Dis 181:532–539CrossRefPubMedGoogle Scholar
  71. 71.
    Walter J, Kuhn L, Aldrovandi GM (2008) Advances in basic science understanding of mother-to-child HIV-1 transmission. Curr Opin HIV AIDS 3:146–150CrossRefPubMedGoogle Scholar
  72. 72.
    Becquet R, Bland R, Leroy V et al (2009) Duration, pattern of breastfeeding and postnatal transmission of HIV-1: pooled analyses of individual data from West and South African cohorts. PLoS One 4:e7397CrossRefPubMedGoogle Scholar
  73. 73.
    Coutsoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM (1999) Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. South African Vitamin A Study Group. Lancet 354:471–476CrossRefPubMedGoogle Scholar
  74. 74.
    Kuhn L, Sinkala M, Kankasa C et al (2007) High uptake of exclusive breastfeeding and reduced early post-natal HIV-1 transmission. PLoS One 2:e1363CrossRefPubMedGoogle Scholar
  75. 75.
    Kourtis AP, Jamieson DJ, de Vincenzi I et al (2007) Prevention of human immunodeficiency virus-1 transmission to the infant through breastfeeding: new developments. Am J Obstet Gynecol 197:S113–S122CrossRefPubMedGoogle Scholar
  76. 76.
    Gantt S, Shetty AK, Seidel KD et al (2007) Laboratory indicators of mastitis are not associated with elevated HIV-1 DNA loads or predictive of HIV-1 RNA loads in breast milk. J Infect Dis 196:570–576CrossRefPubMedGoogle Scholar
  77. 77.
    Neville MO, Allen JC, Archer P et al (1991) Studies in human lactation: milk volume and nutrient composition during weaning and lactogenesis. Am J Clin Nutr 54:81–92PubMedGoogle Scholar
  78. 78.
    Lehman DA, Chung MH, John-Stewart GC et al (2008) HIV-1 persists in breast milk cells despite antiretroviral treatment to prevent mother-to-child transmission. AIDS 22:1475–1485CrossRefPubMedGoogle Scholar
  79. 79.
    Connor EM, Sperling RS, Gelber R et al (1994) Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 331:1173–80CrossRefPubMedGoogle Scholar
  80. 80.
    Shaffer N, Chuachoowong R, Mock PA et al (1999) Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial. Bangkok Collaborative Perinatal HIV-1 Transmission Study Group. Lancet 353:773–80CrossRefPubMedGoogle Scholar
  81. 81.
    Dabis F, Msellati P, Meda N et al (1999) 6-Month efficacy, tolerance, and acceptability of a short regimen of oral zidovudine to reduce vertical transmission of HIV-1 in breastfed children in Côte d’Ivoire and Burkina Faso: a double-blind placebo-controlled multicentre trial. DITRAME Study Group. Diminution de la Transmission Mère-Enfant. Lancet 353:786–92CrossRefPubMedGoogle Scholar
  82. 82.
    Wiktor SZ, Ekpini E, Karon JM et al (1999) Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan, Côte d’Ivoire: a randomized trial. Lancet 353:781–785CrossRefPubMedGoogle Scholar
  83. 83.
    Leroy V, Karon J, Alioum A et al (2002) Twenty-four month efficacy of a maternal short-course zidovudine regimen to prevent mother-to-child transmission of HIV-1 in West Africa. AIDS 16:631–641CrossRefPubMedGoogle Scholar
  84. 84.
    Guay LA, Musoke P, Fleming T et al (1999) Intrapartum and neonatal single dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIV-1NET 012 randomized trial. Lancet 354:795–802PubMedGoogle Scholar
  85. 85.
    Jackson JB, Musoke P, Fleming T et al (2003) Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 randomised trial. Lancet 362:859–868CrossRefPubMedGoogle Scholar
  86. 86.
    Marseille E, Kahn JG, Mmiro F et al (1999) Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa. Lancet 354:803–9PubMedGoogle Scholar
  87. 87.
    The Petra Study Team (2002) Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa and Uganda [Petra Study]: a randomized, double blind, placebo-controlled trial. Lancet 359:1178–1186CrossRefGoogle Scholar
  88. 88.
    Vyankandondera J, Lutchers S, Hassink E et al (2003) Reducing risk of HIV-1 transmission from mother to infant through breastfeeding using antiretroviral prophylaxis in infants (SIMBA). In: 2nd IAS conference on HIV-1 pathogenesis, treatment and prevention, Paris, France, 2003; Abstract LB07Google Scholar
  89. 89.
    Kilewo C, Karlsson K, Massawe A et al (2008) Prevention of mother-to-child transmission of HIV-1 through breast-feeding by treating infants prophylactically with lamivudine in Dar es Salaam, Tanzania: The Mitra Study. J Acquir Immune Defic Syndr 48:315–323CrossRefPubMedGoogle Scholar
  90. 90.
    Six Week Extended-Dose Nevirapine (SWEN) Study Team (2008) Extended-dose nevirapine to 6 weeks of age for infants to prevent HIV-1 transmission via breastfeeding in Ethiopia, India, and Uganda: an analysis of three randomised controlled trials. Lancet 372:300–13CrossRefGoogle Scholar
  91. 91.
    Kumwenda NI, Hoover DR, Mofenson LM et al (2008) Extended antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med 359:119–29CrossRefPubMedGoogle Scholar
  92. 92.
    Coovadia H, Brown E, Maldonado B et al (2011) HPTN 046: efficacy of extended daily infant nevirapine through age 6 months compared to 6 weeks for prevention of postnatal mother-to-child transmission (MTCT) of HIV-1 through breastfeeding (BF). In: 18th conference on retroviruses and opportunistic infections program abstract book, Boston, 2011; Abstract 123LBGoogle Scholar
  93. 93.
    Chasela CS, Hudgens MG, Jamieson DJ et al (2010) Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. N Engl J Med 362:2271–81CrossRefPubMedGoogle Scholar
  94. 94.
    Kilewo C, Karlsson K, Ngarina M et al (2009) Prevention of mother to child transmission of HIV-1 through breastfeeding by treating mothers with triple antiretroviral therapy in Dar es Salaam, Tanzania: the MITRA-PLUS study. J Acquir Immune Defic Syndr 52:406–16CrossRefPubMedGoogle Scholar
  95. 95.
    Thomas T, Masaba R, Borkowf CG et al (2011) Triple antiretroviral prophylaxis to prevent mother-to-child HIV-1 transmission through breastfeeding–The Kisumu Breastfeeding Study, Kenya: a clinical trial. PLoS Med e1001015Google Scholar
  96. 96.
    Peltier CA, Ndayisaba GF, Lepage P et al (2009) Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda. AIDS 23:2415–23CrossRefPubMedGoogle Scholar
  97. 97.
    The Kesho Bora Study Group (2011) Triple antiretrovirals compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. Lancet 3099(10):70288-7Google Scholar
  98. 98.
    The Kesho Bora Study Group (2010) Eighteen-month follow-up of HIV-1 infected mothers and their children enrolled in the Kesho Bora study observational cohorts. J Acquir Immune Defic Syndr 54:553–41Google Scholar
  99. 99.
    Shapiro RL, Hughes MD, Ogwu A et al (2010) Antiretroviral regimens in pregnancy and breastfeeding in Botswana. N Engl J Med 362:2282–94CrossRefPubMedGoogle Scholar
  100. 100.
    Creek TL, Kim A, Lu L, Bowen A et al (2010) Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006. J Acquir Immune Defic Syndr 53:14–9CrossRefPubMedGoogle Scholar
  101. 101.
    Homsy J, Moore D, Barasa A et al (2010) Breastfeeding, mother-to-child HIV-1 transmission, and mortality among infants born to HIV-1-Infected women on highly active antiretroviral therapy in rural Uganda. J Acquir Immune Defic Syndr 53:28–35CrossRefPubMedGoogle Scholar
  102. 102.
    Thomas T, Masaba R, van Eijk A et al (2007) Rates of diarrhea associated with early weaning among infants in Kisumu, Kenya [Abstract 774]. In: 14th conference on retroviruses and opportunistic infections, Los Angeles, CA, 2007Google Scholar
  103. 103.
    HIV-1 and infant feeding technical consultation held on behalf of the Inter-Agency Task Team (IATT) on prevention of HIV-1 infections in pregnant women, mothers and their infants. Consensus statement, Geneva, 25–27 October 2006Google Scholar
  104. 104.
    World Health Organization (2010) Guidelines on HIV-1 and infant feeding. Principles and recommendations for infant feeding in the context of HIV-1 and a summary of evidence. pp 1–49. Accessed 16 Feb 2011
  105. 105.
    Stringer EM, Ekouevi DK, Coetzee D et al (2010) Coverage of nevirapine-based services to prevent mother-to-child HIV transmission in 4 African countries. JAMA 304:293–302CrossRefPubMedGoogle Scholar
  106. 106.
    Kourtis AP, Bulterys M (2010) Mother-to-child transmission of HIV-1: pathogenesis, mechanisms and pathways. Clin Perinatol 37:721–38CrossRefPubMedGoogle Scholar
  107. 107.
    Eslahpazir J, Jenabian MA, Bouhlal H et al (2008) Infection of macrophages and dendritic cells with primary R5-tropic HIV-1 type 1 inhibited by natural polyreactive anti-CCR5 antibodies purified from cervicovaginal secretions. Clin Vaccine Immunol 15:872–84CrossRefPubMedGoogle Scholar
  108. 108.
    Ward S (2001) Natural anti-HIV-1 antibodies. Trends Immunol 22:544PubMedGoogle Scholar
  109. 109.
    de Perre V, Simonon A, Hitimana DG et al (1993) Infective and anti-infective properties of breast milk from HIV-1 infected women. Lancet 341:914–918CrossRefPubMedGoogle Scholar
  110. 110.
    Farquhar C, Rowland-Jones S, Mbori-Ngacha D et al (2004) Human leukocyte antigen (HLA) B*18 and protection against mother-to-child HIV-1 type 1 transmission. AIDS Res Hum Retrovir 20:692–697CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Mary Glenn Fowler
    • 1
    • 2
  • Athena P. Kourtis
    • 3
  • Jim Aizire
    • 4
  • Carolyne Onyango-Makumbi
    • 4
  • Marc Bulterys
    • 5
    • 6
    • 7
  1. 1.Department of PathologyJohns Hopkins Medical InstitutesBaltimoreUSA
  2. 2.Onsite Makerere University–Johns Hopkins University Research CollaborationKampalaUganda
  3. 3.Division of Reproductive HealthNCCDPHP, Centers for Disease Control and PreventionAtlantaUSA
  4. 4.Makerere University–Johns Hopkins University Research CollaborationKampalaUganda
  5. 5.Division of Global HIV/AIDS (DGHA)Center for Global Health, Centers for Disease Control and Prevention (CDC)AtlantaUSA
  6. 6.CDC Global AIDS ProgramBeijingChina
  7. 7.UCLA School of Public HealthLos AngelesUSA

Personalised recommendations