Science's AIDS Prevention and Vaccine Research Site

The additional risk of an infant acquiring human immunodeficiency virus type 1 (HIV) from its HIV+ mother during breast-feeding is about 15% after 24 months and depends on the duration of breast-feeding. This statistic has been exploited to inflate the disadvantages of breast-feeding. It may be more pertinent for health workers to quote a risk of about 5% if breast-feeding is practiced for 6 months, as will be the case in many programs that recommend shorter periods of breast-feeding for HIV-infected women. This review covers recent studies that highlight methodological complexities, the hazards of formula feeding in Africa, and the finding that the type of breast-feeding may influence transmission risks. Important additional risk factors include breast-milk cell-free viral load and breast health including subclinical mastitis. Interventions that have the potential to reduce breast-feeding transmission include safer obstetric practices, prevention and treatment of infant oral thrush, lactation management, shorter duration of breast-feeding, exclusive breast-feeding, antiretrovirals (to mother and infant) during breast-feeding, and heat treatment of expressed breast milk. HIV-infected mothers should be counseled to avoid any new HIV infection by abstaining from sex or using condoms.