HIV-1 and breastfeeding: Biology of transmission and advances in prevention

Clinics in Perinatology

Volumn 37, Issue 4, 2010, Pages 807-824

  Bulterys, Marc ^a,b   Ellington, Sascha ^c   Kourtis, Athena P ^c  

^a CENTERS FOR DISEASE CONTROL AND PREVENTION   (United States)

^b CENTERS FOR DISEASE CONTROL AND PREVENTION   (United States)

^c NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION   (United States)

Author keywords

Antiretroviral prophylactic treatment; Breastfeeding; HIV 1; Mother to child HIV transmission

Indexed keywords

ABACAVIR PLUS LAMIVUDINE PLUS ZIDOVUDINE; ANTIRETROVIRUS AGENT; CHLOROQUINE; EFAVIRENZ; EFAVIRENZ PLUS EMTRICITABINE PLUS TENOFOVIR DISOPROXIL; EMTRICITABINE PLUS TENOFOVIR DISOPROXIL; HUMAN IMMUNODEFICIENCY VIRUS ANTIBODY; HUMAN IMMUNODEFICIENCY VIRUS VACCINE; LAMIVUDINE; LAMIVUDINE PLUS ZIDOVUDINE; LOPINAVIR PLUS RITONAVIR; NEUTRALIZING ANTIBODY; NEVIRAPINE; PLACEBO; TENOFOVIR; VIRUS VECTOR; ZIDOVUDINE;

ANTIVIRAL RESISTANCE; ARTIFICIAL MILK; BREAST ABSCESS; BREAST FEEDING; CD4 LYMPHOCYTE COUNT; CLINICAL TRIAL; DISEASE FREE SURVIVAL; DRUG BLOOD LEVEL; DRUG MILK LEVEL; HEAT TREATMENT; HIGHLY ACTIVE ANTIRETROVIRAL THERAPY; HIV EDUCATION; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS 1 INFECTION; INFANT MORTALITY; MASTITIS; MATERNAL NUTRITION; MOUTH ULCER; NEUTROPENIA; PASSIVE IMMUNIZATION; PRIORITY JOURNAL; REVIEW; SINGLE DRUG DOSE; THRUSH; VERTICAL TRANSMISSION; VIRUS INACTIVATION; VIRUS LOAD; VIRUS SHEDDING; VIRUS TRANSMISSION;

ANTI-RETROVIRAL AGENTS; BREAST FEEDING; FEMALE; HIV INFECTIONS; HIV-1; HUMANS; INFANT; INFANT, NEWBORN; MILK, HUMAN; PRACTICE GUIDELINES AS TOPIC; PRIMARY PREVENTION; VIRAL LOAD; VIRAL VACCINES; VIRUS INACTIVATION; WORLD HEALTH ORGANIZATION;

EID: 78349296368     PISSN: 00955108     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.clp.2010.08.001     Document Type: Review

References (106)

1. UNAIDS. AIDS Epidemic update: November 2009. Available at: Geneva (Switzerland). Accessed May 14, 2010. http://data.unaids.org/pub/Report/2009/jc1700_epi_update_2009_en.pdf.
2. Gaur A.H., Dominguez K.L., Kalish M.L., et al. Practice of feeding premasticated food to infants: a potential risk factor for HIV transmission. Pediatrics 2009, 124:658-666.
3. Horvath T., Madi B.C., Iuppa I.M., et al. Interventions for preventing late postnatal mother-to-child transmission of HIV. Cochrane Database Syst Rev 2009, 1. CD006734.
4. Nduati R., John G., Mbori-Ngacha D., et al. Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial. JAMA 2000, 283:1167-1174.
5. World Health Organization HIV transmission through breastfeeding: a review of available evidence Available at:, Accessed April 20, 2010. http://www.unfpa.org/upload/lib_pub_file/276_filename_HIV_PREV_BF_GUIDE_ENG.pdf.
6. World Health Organization Report of a WHO technical consultation on birth spacing Available at:, Accessed April 20, 2010. http://www.who.int/making_pregnancy_safer/documents/birth_spacing.pdf.
7. Achievements in public health Reduction in perinatal transmission of HIV infection-United States, 1985-2005. MMWR Morb Mortal Wkly Rep 2006, 55:592-597.
8. World Health Organization. Rapid advice: revised WHO principles and recomendations on infant feeding in the context of HIV - November 2009. Available at: 2009. Geneva (Switzerland). Accessed April 20, 2010. http://www.searo.who.int/LinkFiles/HIV-AIDS_Rapid_Advice_Infant_feeding(web).pdf.
9. Kourtis A.P., Butera S., Ibegbu C., et al. Breast milk and HIV-1: vector of transmission or vehicle of protection?. Lancet Infect Dis 2003, 3:786-793.
10. Toniolo A., Serra C., Conaldi P.G., et al. Productive HIV-1 infection of normal human mammary epithelial cells. AIDS 1995, 9:859-866.
11. Lewis P., Nduati R., Kreiss J.K., et al. Cell-free human immunodeficiency virus type 1 in breast milk. J Infect Dis 1998, 177:34-39.
12. Rousseau C.M., Nduati R.W., Richardson B.A., et al. Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease. J Infect Dis 2003, 187:741-747.
13. Lunney K.M., Iliff P., Mutasa K., et al. Associations between breast milk viral load, mastitis, exclusive breast-feeding, and postnatal transmission of HIV. Clin Infect Dis 2010, 50:762-769.
14. Willumsen J.F., Filteau S.M., Coutsoudis A., et al. Breastmilk RNA viral load in HIV-infected South African women: effects of subclinical mastitis and infant feeding. AIDS 2003, 17:407-414.
15. Hartmann S.U., Berlin C.M., Howett M.K. Alternative modified infant-feeding practices to prevent postnatal transmission of human immunodeficiency virus type 1 through breast milk: past, present, and future. J Hum Lact 2006, 22:75-88.
16. Rousseau C.M., Nduati R.W., Richardson B.A., et al. Association of levels of HIV-1-infected breast milk cells and risk of mother-to-child transmission. J Infect Dis 2004, 190:1880-1888.
17. Giuliano M., Guidotti G., Andreotti M., et al. Triple antiretroviral prophylaxis administered during pregnancy and after delivery significantly reduces breast milk viral load: a study within the Drug Resource Enhancement Against AIDS and Malnutrition Program. J Acquir Immune Defic Syndr 2007, 44:286-291.
18. Shapiro R.L., Ndung'u T., Lockman S., et al. Highly active antiretroviral therapy started during pregnancy or postpartum suppresses HIV-1 RNA, but not DNA, in breast milk. J Infect Dis 2005, 192:713-719.
19. Farquhar C., VanCott T.C., Mbori-Ngacha D.A., et al. Salivary secretory leukocyte protease inhibitor is associated with reduced transmission of human immunodeficiency virus type 1 through breast milk. J Infect Dis 2002, 186:1173-1176.
20. Van de Perre P., Simonon A., Hitimana D.G., et al. Infective and anti-infective properties of breastmilk from HIV-1-infected women. Lancet 1993, 341:914-918.
21. Walter J., Kuhn L., Aldrovandi G.M. Advances in basic science understanding of mother-to-child HIV-1 transmission. Curr Opin HIV AIDS 2008, 3:146-150.
22. Villamor E., Koulinska I.N., Furtado J., et al. Long-chain n-6 polyunsaturated fatty acids in breast milk decrease the risk of HIV transmission through breastfeeding. Am J Clin Nutr 2007, 86:682-689.
23. Becquart P., Hocini H., Garin B., et al. Compartmentalization of the IgG immune response to HIV-1 in breast milk. AIDS 1999, 13:1323-1331.
24. Van de Perre P., Simonon A., Msellati P., et al. Postnatal transmission of human immunodeficiency virus type 1 from mother to infant. A prospective cohort study in Kigali. Rwanda. N Engl J Med 1991, 325:593-598.
25. Becquart P., Hocini H., Levy M., et al. Secretory anti-human immunodeficiency virus (HIV) antibodies in colostrum and breast milk are not a major determinant of the protection of early postnatal transmission of HIV. J Infect Dis 2000, 181:532-539.
26. Duprat C., Mohammed Z., Datta P., et al. Human immunodeficiency virus type 1 IgA antibody in breast milk and serum. Pediatr Infect Dis J 1994, 13:603-608.
27. Kuhn L., Trabattoni D., Kankasa C., et al. HIV-specific secretory IgA in breast milk of HIV-positive mothers is not associated with protection against HIV transmission among breast-fed infants. J Pediatr 2006, 149:611-616.
28. Kourtis A.P., Ibegbu C.C., Theiler R., et al. Breast milk CD4+ T cells express high levels of C chemokine receptor 5 and CXC chemokine receptor 4 and are preserved in HIV-infected mothers receiving highly active antiretroviral therapy. J Infect Dis 2007, 195:965-972.
29. Ichikawa M., Sugita M., Takahashi M., et al. Breast milk macrophages spontaneously produce granulocyte-macrophage colony-stimulating factor and differentiate into dendritic cells in the presence of exogenous interleukin-4 alone. Immunology 2003, 108:189-195.
30. Naarding M.A., Dirac A.M., Ludwig I.S., et al. Bile salt-stimulated lipase from human milk binds DC-SIGN and inhibits human immunodeficiency virus type 1 transfer to CD4+ T cells. Antimicrob Agents Chemother 2006, 50:3367-3374.
31. Requena M., Bouhlal H., Nasreddine N., et al. Inhibition of HIV-1 transmission in trans from dendritic cells to CD4+ T lymphocytes by natural antibodies to the CRD domain of DC-SIGN purified from breast milk and intravenous immunoglobulins. Immunology 2008, 123:508-518.
32. John-Stewart G.C., Mbori-Ngacha D., Payne B.L., et al. HIV-1-specific cytotoxic T lymphocytes and breast milk HIV-1 transmission. J Infect Dis 2009, 199:889-898.
33. Farquhar C., Rowland-Jones S., Mbori-Ngacha D., et al. Human leukocyte antigen (HLA) B*18 and protection against mother-to-child HIV type 1 transmission. AIDS Res Hum Retroviruses 2004, 20:692-697.
34. Mackelprang R.D., John-Stewart G., Carrington M., et al. Maternal HLA homozygosity and mother-child HLA concordance increase the risk of vertical transmission of HIV-1. J Infect Dis 2008, 197:1156-1161.
35. Coutsoudis A., Pillay K., Spooner E., et al. Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. South African Vitamin A Study Group. Lancet 1999, 354:471-476.
36. Iliff P.J., Piwoz E.G., Tavengwa N.V., et al. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS 2005, 19:699-708.
37. Kuhn L., Sinkala M., Kankasa C., et al. High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission. PLoS One 2007, 2. e1363.
38. Kourtis A.P., Jamieson D.J., de Vincenzi I., et al. Prevention of human immunodeficiency virus-1 transmission to the infant through breastfeeding: new developments. Am J Obstet Gynecol 2007, 197:S113-S122.
39. Gantt S., Shetty A.K., Seidel K.D., et al. Laboratory indicators of mastitis are not associated with elevated HIV-1 DNA loads or predictive of HIV-1 RNA loads in breast milk. J Infect Dis 2007, 196:570-576.
40. Dunn D.T., Newell M.L., Ades A.E., et al. Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet 1992, 340:585-588.
41. Miotti P.G., Taha T.E., Kumwenda N.I., et al. HIV transmission through breastfeeding: a study in Malawi. JAMA 1999, 282:744-749.
42. Embree J.E., Njenga S., Datta P., et al. Risk factors for postnatal mother-child transmission of HIV-1. AIDS 2000, 14:2535-2541.
43. Moodley D., Moodley J., Coovadia H., et al. A multicenter randomized controlled trial of nevirapine versus a combination of zidovudine and lamivudine to reduce intrapartum and early postpartum mother-to-child transmission of human immunodeficiency virus type 1. J Infect Dis 2003, 187:725-735.
44. Coutsoudis A., Dabis F., Fawzi W., et al. Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis. J Infect Dis 2004, 189:2154-2166.
45. Bulterys M., Chao A., Dushimimana A., et al. HIV-1 seroconversion after 20 months of age in a cohort of breastfed children born to HIV-1-infected women in Rwanda. AIDS 1995, 9:93-94.
46. Koulinska I.N., Villamor E., Msamanga G., et al. Risk of HIV-1 transmission by breastfeeding among mothers infected with recombinant and non-recombinant HIV-1 genotypes. Virus Res 2006, 120:191-198.
47. Gantt S, Katzenstein D, Shetty A, et al. Associations between breast milk cellularity, microbial pathogens, and viral shedding in HIV-1-infected women. 13th Annual Conference on Retroviruses and Opportunistic Infections Available at:, Accessed May 2, 2006. http://www.retroconference.org/2006/Abstracts/26205.HTM.
48. Thea D.M., Aldrovandi G., Kankasa C., et al. Post-weaning breast milk HIV-1 viral load, blood prolactin levels and breast milk volume. AIDS 2006, 20:1539-1547.
49. John G.C., Nduati R.W., Mbori-Ngacha D.A., et al. Correlates of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission: association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA shedding, and breast infections. J Infect Dis 2001, 183:206-212.
50. Coovadia H.M., Rollins N.C., Bland R.M., et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet 2007, 369:1107-1116.
51. Kafulafula G., Hoover D.R., Taha T.E., et al. Frequency of gastroenteritis and gastroenteritis-associated mortality with early weaning in HIV-1-uninfected children born to HIV-infected women in Malawi. J Acquir Immune Defic Syndr 2010, 53:6-13.
52. Kuhn L., Sinkala M., Semrau K., et al. Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-infected mothers. Clin Infect Dis 2010, 50:437-444.
53. Onyango-Makumbi C., Bagenda D., Mwatha A., et al. Early weaning of HIV-exposed uninfected infants and risk of serious gastroenteritis: findings from two perinatal HIV prevention trials in Kampala, Uganda. Marc J Acquir Immune Defic Syndr 2010, 53:20-27.
54. Leroy V., Karon J.M., Alioum A., et al. Postnatal transmission of HIV-1 after a maternal short-course zidovudine peripartum regimen in West Africa. AIDS 2003, 17:1493-1501.
55. Mmiro F.A., Aizire J., Mwatha A.K., et al. Predictors of early and late mother-to-child transmission of HIV in a breastfeeding population: HIV Network for Prevention Trials 012 experience, Kampala, Uganda. J Acquir Immune Defic Syndr 2009, 52:32-39.
56. Fultz P.N. HIV-1 superinfections: omens for vaccine efficacy?. AIDS 2004, 18:115-119.
57. Kumwenda N., Miotti P.G., Taha T.E., et al. Antenatal vitamin A supplementation increases birth weight and decreases anemia among infants born to human immunodeficiency virus-infected women in Malawi. Clin Infect Dis 2002, 35:618-624.
58. Phiri W., Kasonka L., Collin S., et al. Factors influencing breast milk HIV RNA viral load among Zambian women. AIDS Res Hum Retroviruses 2006, 22:607-614.
59. Semba R.D., Kumwenda N., Taha T.E., et al. Mastitis and immunological factors in breast milk of lactating women in Malawi. Clin Diagn Lab Immunol 1999, 6:671-674.
60. Lehman D.A., Chung M.H., John-Stewart G.C., et al. HIV-1 persists in breast milk cells despite antiretroviral treatment to prevent mother-to-child transmission. AIDS 2008, 22:1475-1485.
61. Dabis F., Msellati P., Meda N., et al. 6-month efficacy, tolerance, and acceptability of a short regimen of oral zidovudine to reduce vertical transmission of HIV in breastfed children in Cote d'Ivoire and Burkina Faso: a double-blind placebo-controlled multicentre trial. DITRAME study group. Diminution de la transmission mèrè-enfant. Lancet 1999, 353:786-792.
62. Guay L.A., Musoke P., Fleming T., et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 1999, 354:795-802.
63. Connor E.M., Sperling R.S., Gelber R., et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994, 331:1173-1180.
64. Cooper E.R., Charurat M., Mofenson L., et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr 2002, 29:484-494.
65. Shaffer N., Chuachoowong R., Mock P.A., et al. Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial. Bangkok collaborative perinatal HIV transmission study group. Lancet 1999, 353:773-780.
66. Wiktor S.Z., Ekpini E., Karon J.M., et al. Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan, Cote d'Ivoire: a randomised trial. Lancet 1999, 353:781-785.
67. Bedri A., Gudetta B., Isehak A., et al. Extended-dose nevirapine to 6 weeks of age for infants to prevent HIV transmission via breastfeeding in Ethiopia, India, and Uganda: an analysis of three randomised controlled trials. Lancet 2008, 372:300-313.
68. Kilewo C., Karlsson K., Ngarina M., et al. Prevention of mother-to-child transmission of HIV-1 through breastfeeding by treating mothers with triple antiretroviral therapy in Dar es Salaam, Tanzania: the Mitra plus study. J Acquir Immune Defic Syndr 2009, 52:406-416.
69. Kumwenda N.I., Hoover D.R., Mofenson L.M., et al. Extended antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med 2008, 359:119-129.
70. Palombi L., Marazzi M.C., Voetberg A., et al. Treatment acceleration program and the experience of the DREAM program in prevention of mother-to-child transmission of HIV. AIDS 2007, 21(Suppl 4):S65-S71.
71. Thomas R., Masaba R., Ndivo R., et al. Kisumu breastfeeding study team. prevention of mother-to-child transmission of HIV-1 among breastfeeding mothers using haart: the kisumu breastfeeding study, kisumu, kenya, 2003-2007. 15th Conference on Retroviruses and Opportunistic Infections Available at:, Accessed May 4, 2010. http://www.retroconference.org/2008/Abstracts/33397.htm.
72. Shapiro R.L., Hughes M., Ogwu A., et al. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med 2010, 362:2282-2294.
73. de Vincenzi, I, Kesho Bora Study Group. Triple-antiretroviral (ARV) prophylaxis during pregnancy and breastfeeding compared to short-ARV prophylaxis to prevent mother-to-child transmission of HIV-1 (MTCT): the Kesho Bora randomized controlled clinical trial in five sites in Burkina Faso, Kenya. Proceedings of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. 2009. Accessed July 19, 2009.
74. Chasela C., Hudgens M., Jamieson D., et al. Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. N Engl J Med 2010, 362:2271-2281.
75. Kilewo C., Karlsson K., Massawe A., et al. Prevention of mother-to-child transmission of HIV-1 through breast-feeding by treating infants prophylactically with lamivudine in Dar es Salaam, Tanzania: the Mitra study. J Acquir Immune Defic Syndr 2008, 48:315-323.
76. Bulterys M., Fowler M.G., Van Rompay K.K., et al. Prevention of mother-to-child transmission of HIV-1 through breast-feeding: past, present, and future. J Infect Dis 2004, 189:2149-2153.
77. Mofenson L.M. Prevention of breast milk transmission of HIV: the time is now. J Acquir Immune Defic Syndr 2009, 52:305-308.
78. Moorthy A., Gupta A., Bhosale R., et al. Nevirapine resistance and breast-milk HIV transmission: effects of single and extended-dose nevirapine prophylaxis in subtype C HIV-infected infants. PLoS One 2009, 4. e4096.
79. ClinicalTrials.gov Comparison of efficacy and safety of infant peri-exposure prophylaxis with lopinavir/ritonavir versus lamivudine to prevent HIV-1 transmission by breastfeeding Available at:, updated April 8, 2010. Accessed April 30, 2010. http://clinicaltrials.gov/ct2/show/NCT00640263.
80. Peltier C.A., Ndayisaba G.F., Lepage P., et al. Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda. AIDS 2009, 23:2415-2423.
81. Zeh C., Weidle P., Nafisa L., et al. Emergence of HIV-1 drug resistance among breastfeeding infants born to hiv-infected mothers taking antiretrovirals for prevention of mother-to-child transmission of hiv: the kisumu breastfeeding study, kenya. 15th Conference on Retroviruses and Opportunistic Infections Available at:, Accessed April 20, 2010. http://www.retroconference.org/AbstractSearch/Default.aspx?Conf%20=%2019.
82. Darwich L., Esteve A., Ruiz L., et al. Variability in the plasma concentration of efavirenz and nevirapine is associated with genotypic resistance after treatment interruption. Antivir Ther 2008, 13:945-951.
83. Mirochnick M., Thomas T., Capparelli E., et al. Antiretroviral concentrations in breast-feeding infants of mothers receiving highly active antiretroviral therapy. Antimicrob Agents Chemother 2009, 53:1170-1176.
84. ClinicalTrials.gov Evaluating strategies to reduce mother-to-child transmission of HIV infection in resource-limited countries (PROMISE) Available at:, updated April 14, 2010. Accessed April 30, 2010. http://clinicaltrials.gov/ct2/show/NCT01061151.
85. ClinicalTrials gov: Universal Use of EFV-TDF-FTC and AZT-3TC-LPV/r Combinations for HIV-1 PMTCT in Pregnant and breastfeeding women: a Phase 3 Trial (UMA) Available at:, updated August 6, 2009. Accessed April 30, 2010. http://clinicaltrials.gov/ct2/show/NCT00936195?term%20=%20UMA&rank=1.
86. Luzuriaga K., Newell M.L., Dabis F., et al. Vaccines to prevent transmission of HIV-1 via breastmilk: scientific and logistical priorities. Lancet 2006, 368:511-521.
87. Cunningham C.K., McFarland E. Vaccines for prevention of mother-to-child transmission of HIV. Curr Opin HIV AIDS 2008, 3:151-154.
88. HIV Prevention Trials Network: HPTN 027 A Phase I Study to Evaluate the Safety and Immunogenicity of ALVAC-HIV vCP1521 in Infants Born to HIV-1 Infected Women in Uganda Available at:, Accessed April 20, 2010. http://www.hptn.org/research_studies/hptn027.asp.
89. ClinicalTrials.gov Safety and immunogenicity study of candidate HIV-1 vaccine given to healthy infants born to hiv-1-infected mothers (PedVacc002) Available at:, updated October 10, 2009. Accessed April 20, 2010. http://clinicaltrials.gov/ct2/show/NCT00981695.
90. Guay L.A., Musoke P., Hom D.L., et al. Phase I/II trial of HIV-1 hyperimmune globulin for the prevention of HIV-1 vertical transmission in Uganda. AIDS 2002, 16:1391-1400.
91. ClinicalTrials.gov Nevirapine Study for the Prevention of Maternal-Infant HIV Transmission in Uganda Available at:, updated April 1, 2008. Accessed April 20, 2010. http://clinicaltrials.gov/ct2/show/NCT00639938.
92. Hartmann S.U., Wigdahl B., Neely E.B., et al. Biochemical analysis of human milk treated with sodium dodecyl sulfate, an alkyl sulfate microbicide that inactivates human immunodeficiency virus type 1. J Hum Lact 2006, 22:61-74.
93. Boelaert J.R., Yaro S., Augustijns P., et al. Chloroquine accumulates in breast-milk cells: potential impact in the prophylaxis of postnatal mother-to-child transmission of HIV-1. AIDS 2001, 15:2205-2207.
94. Savarino A., Gennero L., Chen H.C., et al. Anti-HIV effects of chloroquine: mechanisms of inhibition and spectrum of activity. AIDS 2001, 15:2221-2229.
95. Luchters SM, Veldhuijzen J, Nsanzabera D. A phase I/II randomized, placebo controlled study to evaluate chloroquine administration to reduce HIV-1 RNA in breast milk in an HIV-1 infected breastfeeding population: the CHARGE Study. Proceedings of the 15th International AIDS Conference. 2004. Accessed November 7, 2004.
96. Jeffery B.S., Mercer K.G. Pretoria pasteurisation: a potential method for the reduction of postnatal mother to child transmission of the human immunodeficiency virus. J Trop Pediatr 2000, 46:219-223.
97. Jeffery B.S., Webber L., Mokhondo K.R., et al. Determination of the effectiveness of inactivation of human immunodeficiency virus by Pretoria pasteurization. J Trop Pediatr 2001, 47:345-349.
98. Jeffery B.S., Soma-Pillay P., Makin J., et al. The effect of Pretoria Pasteurization on bacterial contamination of hand-expressed human breastmilk. J Trop Pediatr 2003, 49:240-244.
99. Orloff S.L., Wallingford J.C., McDougal J.S. Inactivation of human immunodeficiency virus type I in human milk: effects of intrinsic factors in human milk and of pasteurization. J Hum Lact 1993, 9:13-17.
100. Israel-Ballard K., Donovan R., Chantry C., et al. Flash-heat inactivation of HIV-1 in human milk: a potential method to reduce postnatal transmission in developing countries. J Acquir Immune Defic Syndr 2007, 45:318-323.
101. Chantry C.J., Israel-Ballard K., Moldoveanu Z., et al. Effect of flash-heat treatment on immunoglobulins in breast milk. J Acquir Immune Defic Syndr 2009, 51:264-267.
102. Breastfeeding and HIV International Transmission Study Group Mortality among HIV-1-infected women according to children's feeding modality: an individual patient data meta-analysis. J Acquir Immune Defic Syndr 2005, 39:430-438.
103. Nduati R., Richardson B.A., John G., et al. Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial. Lancet 2001, 357:1651-1655.
104. Kuhn L., Aldrovandi G.M., Sinkala M., et al. Effects of early, abrupt weaning on HIV-free survival of children in Zambia. N Engl J Med 2008, 359:130-141.
105. Thior I., Lockman S., Smeaton L.M., et al. Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi study. JAMA 2006, 296:794-805.
106. Bulterys M., Wilfert C.M. HAART during pregnancy and during breastfeeding among HIV-infected women in the developing world: has the time come? [editorial]. AIDS 2009, 23:2473-2477.