Breast-feeding and Transmission of HIV-1.
Breast-feeding substantially increases the risk of HIV-1 transmission from mother to child, and although peripartum antiretroviral therapy prophylaxis significantly decreases the risk of mother-to-child transmission around the time of delivery, this approach does not affect breast-feeding transmission. Increased maternal RNA viral load in plasma and breast milk is strongly associated with increased risk of transmission through breast-feeding, as is breast health, and it has been suggested that exclusive breast-feeding could be associated with lower rates of breast-feeding transmission than mixed feeding of both breast- and other milk or feeds. Transmission through breast-feeding can take place at any point during lactation, and the cumulative probability of acquisition of infection increases with duration of breast-feeding. HIV-1 has been detected in breast milk in cell-free and cellular compartments; infant gut mucosal surfaces are the most likely site at which transmission occurs. Innate and acquired immune factors may act most effectively in combination to prevent primary HIV-1 infection by breast milk.
John-Stewart
Grace
G
Department of Medicine, University of Washington, USA.
Mbori-Ngacha
Dorothy
D
Ekpini
Rene
R
Janoff
Edward N
EN
Nkengasong
John
J
Read
Jennifer S
JS
Van de Perre
Phillippe
P
Newell
Marie-Louise
ML
D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control / Q000635:transmission*; D001942:Breast Feeding / Q000009:adverse effects*; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1 / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008895:Milk, Human / Q000821:virology*; D012307:Risk Factors