Apparent vertical transmission of human immunodeficiency virus type 1 by breast-feeding in Zambia

Human immunodeficiency virus type 1 (HIV), the agent which causes AIDS, can be transmitted from mother to child during pregnancy, labor, or the postpartum period. HIV has been found in breast milk, but the significance of this to AIDS transmission has been unclear. To determine whether breast-feeding is a significant source of HIV transmission, the risk factors for maternal HIV infection and for transmission to infants were studied in 1,954 African women who recently gave birth. Of these, 1,720 women tested negative for HIV, but only 634 women returned for follow-up testing one year later. Nineteen women in this group subsequently tested positive for HIV, and 3 of the 19 children became HIV-positive as well. The only known exposure to HIV for these children was through breast-feeding. The risk factors for HIV infection for the women were, from least to greatest risk, husbands with HIV infection; blood transfusions; genital ulcers; and practicing 'dry sex', in which vaginal secretions are removed with a cloth, a practice which may abrade the vagina and facilitate HIV transmission. The study suggests that women who are at high risk of acquiring HIV should not breast-feed their children due to a small risk of transmission. However, in Africa, neither formula feeding nor safe water supplies are generally available or affordable. The advantage of breast-feeding in preventing infant death from diarrheal disease usually is greater than the risk of HIV transmission. (Consumer Summary produced by Reliance Medical Information, Inc.)