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This effect was already reported in the Thai ZDV+sdNVP trial with a significant higher protective effect on HIV infection with longer ARV prophylaxis in a non breastfeeding population [30].
Malnutrition in children under 6 months, a rare occurrence in a breastfeeding population, is also on the increase largely because of HIV/AIDS and inappropriate infant feeding practices.
Since this was a breastfeeding population, the criteria used to determine time of infection was similar to that used by Bertolli et al. [ 19].
Mother to child transmission (MTCT) of HIV occurs at a rate of 15%to40%0% in a breastfeeding population in the absence of prevention measures [ 1].
While the model can be used in a breastfeeding population, it does not allow us to separate intrapartum transmission from early transmission due to breastfeeding.
9, 155– 159 In the HIVNET 012 trial, 157 the initial reduction in perinatal transmission was maintained at 18 months in a breastfeeding population, a finding supported by those in the DITRAME (Diminution de la Transmission Mere Enfant) trial.
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The ultimate efficacy of these regimens maybe reduced in breastfeeding populations due to postnatal transmission [12].
As a consequence, HIV transmission through breastmilk has emerged as a more important mode of paediatric acquisition in African breastfeeding populations [3], and its prevention remains challenging [4].
The absolute long-term efficacy of all scARV regimens administrated in peripartum in African breastfeeding populations is likely to be reduced beyond 4 6 weeks because of the breastfeeding HIV transmission [7].
To our knowledge, this is the first time that such a PMTCT long-term outcome is reported in breastfeeding populations, and these encouraging results are close to those observed in developed countries with more complex PMTCT strategies.
PMTCT interventions are highly effective, with HIV-transmission rates of <5% achievable even in breastfeeding populations [ 8].
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