Women can transmit HIV to their infants prenatally, at delivery or postpartum through breast-feeding. Without any interventions, 30–45% of infants of HIV-infected mothers become infected themselves. In many African countries, antiretroviral drugs, usually nevirapine, are becoming increasingly available for mothers and infants at delivery. Although programmatic data on transmission rates in nevirapine-treated populations are only beginning to become available, it appears that transmission rates by 4–6 weeks postpartum are approximately halved and that total transmission after a variety of low cost interventions in several African trials was 24%. This means that the breast-feeding route of transmission to approximately 16% of infants is becoming the major route of mother-to-child transmission in Sub-Saharan Africa. Unfortunately, even in urban areas of low income countries with potential access to delivery antiretrovirals, replacement feeding is associated with high risk of infant morbidity and mortality from other infections. This dilemma has caused enormous amounts of discussion among researchers and international agency staff and enormous anxiety and stress among women and health care staff in low income countries.
Kasonka, L.; Filteau, S. Exclusive Breast-feeding and HIV Infection. Advances in Experimental Medicine and Biology (2009) 639: 291-298.