Breast-feeding and HIV-1 transmission in resource-limited settings.

In many international settings, transmission of the HIV virus during lactation accounts for one third to one half of all HIV transmission from mothers to infants. Reduction of HIV transmission during lactation is one of the most pressing public health dilemmas confronting perinatal researchers, health policy makers, and HIV-infected women in many areas of the world. While results of clinical trials, laboratory and observational studies have increased our understanding of risk factors for breast-feeding transmission and the timing of postnatal transmission, there are no proven strategies known to reduce the risk of HIV transmission during breast-feeding for those HIV-infected women who opt to breast-feed in developing countries. Approaches to decreasing transmission of HIV through breast-feeding that will be studied include trials of combination antiretrovirals given to mothers during lactation. These research efforts using maternal antiretrovirals for perinatal HIV prevention during breast-feeding will interface with emerging plans for treatment programs in developing countries.