|HIV and Infant Feeding - Review of HIV Transmission Through Breastfeeding Jointly Issued by UNICEF, UNAIDS and WHO Guidelines - Prevention of Mother-to-Child Transmission (UNAIDS, 1998, 26 p.)|
|Explanation of terms|
|HIV infection in women|
|Rates of mother-to-child transmission|
|Evidence for breast-milk transmission|
|Mechanisms of breast-milk transmission|
|Quantifying the risk of breast-milk transmission|
|Timing of HIV transmission during breastfeeding|
|Colostrum and mature milk|
|Factors associated with the risk of mother-to-child transmission|
|Anti-infective properties of breast milk in women with HIV|
|Strategies to reduce breast-milk transmission|
|Early cessation of breastfeeding|
|Treatment of breast milk|
|Wet-nursing by a tested HIV-negative woman|
|Summary and Conclusion|
Adjorlolo-Johnson G, De Cock KM, Ekpini E, et al. Prospective comparison of mother-to-child transmission of HIV-1 and HIV-2 in Abidjan, Ivory Coast. JAMA 1994;272:462-466.
Ait-Khaled M, Lyall EGH, Stainsby C, Taylor GP, et al. Intrapartum mucosal exposure to human immunodeficiency virus type 1 of infants born to HIV-1-infected mothers correlates with maternal plasma virus burden. Journal of Infectious Diseases 1998;177:1097-1100
Akr, ed. Infant feeding: the physiological basis. Bulletin of the World Health Organization, 1990; 67 (Supplement).
American Academy of Pediatrics Policy Statement. Breastfeeding and the Use of Human Milk. Pediatrics. 1997; 100 (6): 1035-1039.
Amerongen HM, Weltzin R, Farnet CM, Michetti P, Haseltine WA, Neutra MR. Transepithelial transport of HIV-1 by intestinal M cells: a mechanism for transmission of AIDS. J Acquir Immune Defic Synd 1991;4:760-765
Andreasson PA, Dias F, Naucler A, Andersson S, Biberfeld G. A prospective study of vertical transmission of HIV-2 in Bissau, Guinea-Bissau. AIDS 1993;7:989-993.
Ankrah ME, Mhloyi MM, Manguyu F, Nduati RW. Women and children and AIDS. In: Essex M, Mboup S, Kanki PJ, Kalengayi MR. AIDS in Africa. Raven Press, Ltd. , New York 1994.
Ashraf RN, Jalil F, Zaman S, Karlberg J, et al. Breastfeeding and protection against neonatal sepsis in a high risk population. Archives of Diseases in Childhood 1991;66:488-490.
Baba TW, Kock J, Mittler M, et al. Mucosal infection of neonatal rhesus monkeys with cell-free SIV. AIDS Research and Human Retroviruses 1994;10:351-357.
Bertolli J, St. Louis, Simonds RJ, et al. Estimating the timing of mother-to-child transmission of human immunodeficiency virus in a breastfeeding population in Kinshasa, Zaire. Journal of Infectious Diseases 1996;174:722-726.
Blanche S, Rouzioux C, Moscatao M-LG, et al. A prospective study of infants born to women seropositive for human immunodeficiency virus type 1. N Engl J Med 1989;320:1643-1648.
Bobat R, Moodley D, Coutsoudis, Coovadia H. Breastfeeding by HIV-1 infected women and outcome in their infants: a cohort study from Durban, South Africa. AIDS 1997;11:1627-1633.
Bomsel M. Transcytosis of infectious human immunodeficiency virus across a tight human epithelial cell line barrier. Nat Med 1997; 3:42-47
Borkowsky W, Krasinski K, Yunzhen C, et al. Correlation of perinatal transmission of human immunodeficiency virus type 1 with maternal viraemia and lymphocyte phenotypes. Journal of Pediatrics 1994;125:345-51.
Boyer PJ, Dillon M, Navaie M, et al. Factors predictive of maternal fetal transmission of HIV-1: preliminary analysis of AZT given during pregnancy and/or delivery. JAMA 1994; 271:1925-1930.
Bridbord K, Willoughby A. Vitamin A and mother-to-child transmission. Lancet 1994; 343:1585-1586.
Bryson YJ, Luzuriaga K, Wara DW. Proposed definitions for in utero versus intrapartum transmission of HIV-1. N Engl J Med 1992;327:1246-1247.
Bryson YJ. Perinatal HIV-1 transmission: recent advances and therapeutic interventions. AIDS 1996;10 (Supplement):S33-S42.
Bulterys M, Landesman S, Burns DN, Rubinstein A and Goedert JJ. Sexual behaviour and injection drug use during pregnancy and vertical transmission of HIV-1. J of Acquir Immune Defic Syndr Human Retrovir 1997;15: 76-82.
Burns DN, Landesman S, Muenz LR, et al. Cigarette smoking, premature rupture of membranes, and vertical transmission of HIV-1 among women with low CD4+ levels. J Acquir Immune Defic Syndr 1994;7:718-726.
Burns DN, Landesman S, Wright DJ, et al. Influence of other maternal variables on the relationship between maternal viral load and mother-to-infant transmission of human immunodeficiency virus type 1. Journal of Infectious Disease, 1997;175:1206-1210.
Centers for Disease Control. Administration of zidovudine during late pregnancy and delivery to prevent perinatal HIV transmission, Thailand, 1996-1998. MMWR 1998;7(8):151-154.
Clerici M, Sison AV, Berzofsky JA, et al. Cellular immune responses associated with mother- to-child transmission of HIV. AIDS 1993;7:1427-1433.
Colebunders R, Kapita B, Nekwei W, et al. Breastfeeding and transmission of HIV. Lancet 1988;2:1487.
Coll O, Hernandez M, Boucher CA, et al. Vertical HIV-1 transmission correlates with a high maternal viral load at delivery. J Acquir Immune Defic Syndr Human Retrovirol 1997;14:26-30.
Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994;331:1174-1179.
Dabis F, Msellati P, Dunn D, et al. Estimating the rate of mother-to-child transmission of HIV. Report of a workshop on methodological issues, February 1992, Ghent, Belgium. AIDS 1993;7:1139-1148.
Datta P, Embree JE, Kreiss JK, et al. Mother-to-child transmission of human immunodeficiency virus type 1: report from the Nairobi study. Journal of Infectious Diseases 1994;170:1134-1140.
Del Fante P, Jenniskens F, Lush L, et al. HIV, breastfeeding and under-five mortality: modelling the impact of policy decisions for or against breastfeeding. Journal of Tropical Medicine and Hygiene 1993;96:203-211.
De Soyza I, Rea M, Martines J, Why promote breastfeeding in diarrhoeal disease control programmes? Health Policy and Planning. 1991; 6 (4): 371-379.
Dickover RE, Garratty EM, Herman SA, et al. Identification of levels of maternal HIV-1 RNA associated with risk of perinatal transmission: effects of maternal zidovudine on viral load. JAMA 1996;275:599-605.
Duncan B, Ey J, Holberg CJ, et al Exclusive breastfeeding for at least 4 months protects against otitis media. Pediatrics. 1993; 91:867-872.
Dunn DT, Newell ML, Ades AE, Peckham C. Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet 1992;340:585-588.
Dunn DT, Newell ML, Mayaux MJ, Kind C, Hutto C, Goedert JJ, Andiman W, and Perinatal AIDS Collaborative Transmission Studies. Mode of Delivery and Vertical Transmission of HIV-1: A Review of Prospective Studies. J Acquir Immune Def Syndr 1994;7:1064-1066
Ekpini E, Wiktor SZ, Satten GA, et al. Late postnatal transmission of HIV-1 in Abidjan, Cote d'Ivoire. Lancet 1997;349:1054-1059.
European Collaborative Study. Risk factors for mother-to-child transmission of HIV-1. Lancet 1992;339:1007-1012.
European Collaborative Study. Caesarean section and risk of transmission of HIV-1 infection. Lancet 1994;343:1464-1467
Featherstone C. M cells: portals to the mucosal immune system. Lancet 1997;350:1230.
Fleming SC, Kapembwa MS, MacDonald TT, Griffin GC. Direct in vitro infection of human intestine with HIV-1. AIDS 1992;6:1099-1104.
Fowler MG. Update on international trials to prevent HIV transmission from mothers to infants. Conference on Global Strategies for the Prevention of HIV Transmission from Mothers to Infants. Edited by Martin N and Amman AJ, September 1997, Washington,DC; 177-180.
Gabiano C, Tovo P-A, de Martino M, et al. Mother-to-child transmission of human immunodeficiency virus type 1: Risk of infection and correlates of transmission. Paediatrics 1992;90:369-374.
Galli L, Tovo P-A, Martino M, et al. Impact of infection status in the father on the rate of HIV-1 transmission from and infected mother to her child. Paediatric AIDS and HIV Infection: Fetus to Adolescent 1993;4:425-428.
Goedert JJ, Duliege AM, Amos CI, et al. Higher risk of HIV infection for first born twins. Lancet 1991;338:1471-1475.
Goedert JJ, Mendez H, Drummond JE, et al. Mother-to-infant transmission of human immunodeficiency virus type 1: association with prematurity or low anti-gp120. Lancet, 1989; i:1351-1355.
Golding J, Emmett PM, Rogers IS, Breastfeeding and infant mortality Early Human Development . 1997; 49 Suppl. S143-S155. .
Goldman A. The immune system of human milk: antimicrobial, antiinflammatory and immunomodulating properties. Pediatr Infect Dis J 1993;12:664-671.
Gray G, McIntyre JA, Lyons SF. The effect of breastfeeding on vertical transmission of HIV-1 in Soweto, South Africa. XI International Conference on AIDS. Vancouver, July 1996 Abstract ThC415.
Greenberg BL, Semba RD, Vink P et al. Vitamin A deficiency and maternal-infant transmission of HIV in two metropolitan areas in the United States. AIDS, 1997;11:325-332
Guay LA, Hom DL, Mmiro F, et al. Detection of human immunodeficiency virus type 1 DNA and p24 antigen in breast milk of HIV-1 infected Ugandan women and vertical transmission. Paediatrics 1996;98:438-444.
Habicht JP, DaVanzo J, Butz W. Does breastfeeding save lives or are apparent benefits due to biases? American Journal of Epidemiology 1986;123:279-289.
Habicht J-P, DaVanzo J, Butz WP, Mother's Milk and Sewage: Their Interactive Effects on Infant Mortality. Pediatrics. 1988; 81: 456-61.
Hancock J, Nalo DS, Aoko M, Mutemi R, Clark H, Forsythe S. The macroeconomic impact of HIV/AIDS. In: AIDS in Kenya: Socioeconomic impact and policy implications. Family Health
Hanson LA, Hofvander Y, Lindquist B, Zetterstrom R. Breastfeeding as a protection against gastroenteritis and other infections. Acta Paediatr Scand 1985;74:641-642.
Harmsen MC, Swart PJ, de Bethune MP. Antiviral effects of plasma and milk proteins: Lactoferrin shows potent activity against both human immunodeficiency virus and human cytomegalovirus replication in vitro. Journal of Infectious Disease 1995;172:380-388.
Henin Y, Mandelbrot L, Henrion R, Pradinaud R, Coulaud JP, Montagnier L. Virus excretion in the cervicovaginal secretions of pregnant and nonpregnant HIV-infected women. J Acquir Immune Defic Synd 1993;6:72-75
Heyman SJ. Modelling the impact of breastfeeding by HIV-infected women on child survival. American Journal of Public Health 1990;80:1305-1309
Hira SK, Mangrola UG, Mwale C, et al. Apparent vertical transmission of human immunodeficiency virus type 1 by breastfeeding in Zambia. Journal of Pediatrics 1990; 117: 421-424.
Holmes KK. The changing epidemiology of HIV transmission. Hospital Practice 1991; November 15:153-177.
Hu DJ, Heyward WL, Byers RH, et al. HIV infection and breastfeeding: policy implications through a decision analysis model. AIDS 1992;6:1505-1513.
Huffman SL, Combest C. Role of breastfeeding in the prevention and treatment of diarrhoea. Journal of Diarrhoeal Diseases Research 1990;8(3):68-81.
Hutto C, Wade PP, Shenghan L, et al. A hospital-based prospective study of perinatal infection with human immunodeficiency virus type 1. Journal of Pediatrics 1991;118:347-53.
Isaacs CE, Thormar H. Human milk lipids inactivate enveloped viruses. In: Atkinson SA, Hanson LA, Chandra RK. Breast feeding, Nutrition Infections and Infant Growth in Developed and Emerging Countries. ARTS Biomedical publishers and Distributors, St John, Newfoundland, Canada, 1990.
Jackson JB, Kataaha P, Hom DL, et al. B-2 microglobulin, HIV-1 p24 antibody and acid dissociated HIV-1 p24 antigen levels; predictive markers for vertical transmission of HIV-1 in pregnant Ugandan women. AIDS 1993;7:1475-1479.
John GC, Nduati RW, Mbori-Ngacha D, et al. Genital shedding of human immunodeficiency virus type 1 DNA during pregnancy: Association with immunosupression, abnormal cervical and vaginal discharge and severe vitamin A deficiency. Journal of Infectious Disease 1997;175:57-62.
Karlsson K, Massawe A, Urassa E et al. Late postnatal transmission of human immunodeficiency virus type 1 infection from mothers to infants in Dar es Salaam, Tanzania. Pediatr Infect Dis J 1997;16:963-967
Kind C, Rudin C, Siegrist CA, et al. Prevention of vertical HIV transmission: additive protective effect of elective caesarean section and zidovudine prophylaxis. AIDS 1998;12:205-210
Kliks SC, Wara DW, Landers DV, Levy JA. Features of HIV-1 that could influence maternal-child transmission. JAMA 1994;272:467-474.
Kuhn L, Abrams EJ, Matheson PB, et al. Timing of maternal-infant transmission: associations between intrapartum factors and early polymerase chain reaction results. AIDS 1997;11:429-435.
Kuhn L, Stein Z. Infant survival, HIV infection and feeding alternatives in less developed countries. American Journal of Public Health 1997;87:926-931.
Lallemant M, Le Coeur S, Samba L, et al. Mother-to-child transmission of HIV-1 in Congo central Africa. AIDS 1994;8:1451-1456.
Lallemant M, Baillou A, Le Coeur S. Maternal antibody response at delivery and perinatal transmission of human immunodeficiency virus type 1 in African women. Lancet 1994;343:1001-1005.
Landesman SH, Kalish LA, Burns DN, et al. Obstetrical factors and the transmission of human immunodeficiency virus type 1 from mother to child. N Engl J Med 1996;334:1617-1623.
Lapointe N, Samson J, Bazet A, Boucher M, Fauvel M, Tran T, et al. Mother-to-child transmission associated with duration of the second stage of labour. XI International Conference on AIDS. Vancouver, July 1996 Abstract C340.
Lawrence R. Breastfeeding: a guide for the medical profession, 4th edition. St. Louis: Mosby, 1994.
Lepage P, Van de Perre P, Carael M, et al. Postnatal transmission of HIV from mother to child. Lancet 1987;ii:400.
Lepage P, Van de Perre, Msellati P, et al. Mother-to-child transmission of human immunodeficiency virus type (HIV-1) and its determinants: a cohort study from Kigali, Rwanda. American Journal of Epidemiology 1993;137:589-599.
Leroy V, Newell ML, Dabis F. International multicentre pooled analysis of late postnatal mother-to-child transmission of HIV infection. Lancet 1998;352:597-600.
Leroy V, Van de Perre P, Lepage P, et al. Seroincidence of HIV-1 infection in African women of reproductive age: a prospective cohort study in Kigali, Rwanda, 1988-1992. AIDS 1994;8:983-936.
Lewis P, Nduati R, Kreiss JK, John GC, et al. Cell-free human immunodeficiency virus type 1 in breast milk. Journal of Infectious Disease 1998;177:7-11.
Lindgren S, Anzen B, Bohlin AB, Lidman K. HIV and child-bearing: clinical outcome and aspects of mother-to-child transmission. AIDS 1991;5:1111-1116.
Loussert-Ajaka I, Mandelbrot L, Delmas MC, et al. HIV-1 detection in cervicovaginal secretions during pregnancy. AIDS 1997;11:1575-1581.
Lucas A, Cole TJ, Breastmilk and neonatal necrotising enterocolitis. Lancet. 1990; 336: 1519-1523.
Lutz-Friedrich R, Grubert TA, Dathe O, et al. QC-PCR quantitation of HIV-1 plasma RNA level during pregnancy: a new prognostic marker for vertical transmission. XI International Conference on AIDS. Vancouver, July 1996, Abstract TuC 2578.
Maguire A, Sanchez E, Fortuny C, et al. Potential risk factors for vertical HIV-1 transmission in Catalonia, Spain: the protective role of caesarean section. AIDS 1997;11:1852-7.
Mandelbrot L, Brossard Y, Aubin JT, et al. Testing for in utero human immunodeficiency virus infection with fetal blood sampling. Am J Obstet Gynecol 1996;175:489-493.
Mandelbrot L, Mayaux MJ, Bongain A, et al. Obstetric factors and mother-to-child transmission of HIV type 1: the French perinatal cohorts. Am J Obstet Gynecol 1996;175:661-667.
Mandelbrot L, Le Chenadec J, Berrebi A, et al. Perinatal HIV-1 transmission: interaction between ziduvodine prophylaxis and mode of delivery in the French perinatal cohort. JAMA 1998;280:55-60.
MAP. Monitoring the AIDS epidemic (MAP) network. The status and trends of the HIV/AIDS/STD epidemics in the world. Provisional report, June 1998.
Matheson PB, Weedon J, Cappelli M, et al. Comparison of methods of estimating the mother- to-child transmission rate of human immunodeficiency virus type 1 (HIV-1). American Journal of Epidemiology 1995;142:714-718.
Matheson PB, Thomas PA, Abrams EJ et al. Heterosexual behaviour during pregnancy and perinatal transmission of HIV-1. AIDS, 1997; 10:1249-1256
Mayaux MJ, Blanche S, Rouzioux C, et al. Maternal factors associated with perinatal HIV-1 transmission: the French cohort study: 7 years of follow-up observation. The French Pediatric HIV Infection Study Group. J Acquir Immune Defic Syndr Human Retrovirol 1995; 8:188-194.
Mayaux MJ, Dussaix E, Isopet J et al. Maternal virus load during pregnancy and mother-to-child transmission of human immunodeficiency virus type 1: the French perinatal cohort study. Journal of Infectious Disease 1997;175:172-175.
Monforte AA, Ravizza M, Muggiasca ML, et al. Maternal predictors of HIV transmission. European Journal of Obstetrics and Gynaecology and Reproductive Biology 1991;42:131-136.
Monteiro CA., Can infant mortality be reduced by promoting breastfeeding? Evidence from Sao Paulo City. Health Policy and Planning 1990; 5: 23-29.
Morgan G, Wilkins HA, Pepin J, Ousman J, Brewster D, Whittle H, et al. AIDS following mother-to-child transmission of HIV-2. AIDS 1990;4:879-882.
Mostad SB, Overbaugh J, DeVange DM, et al. Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina. Lancet 1997;350:922-27.
Mostad SB, Kreiss JK. Shedding of HIV-1 in the genital tract. AIDS 1996;10:1305-1315.
Msellati P., Newell M-L., Dabis F., Rates of mother-to-child transmission of HIV-1 in Africa, America and Europe: Results from 13 perinatal studies Journal of Acquired Immune Deficiency Syndromes 1995;8:506-510.
Nagelkerke NJO, Moses S, Embree JE, et al. The duration of breastfeeding of HIV-1 infected mothers in developing countries: balancing benefits and risks. AIDS 1995;8:176-181.
Nair P, Alger L, Hines S, et al. Maternal and neonatal characteristics associated with HIV infection in infants of seropositive women. Journal of Acquired Immune Deficiency Syndromes 1993;6:298-302.
Nduati R, John G, Kreiss J. Postnatal transmission of HIV-1 through pooled breast milk. Lancet 1994;344:1432.
Nduati R, John G, Richardson B, et al. Human immunodeficiency virus type-1 infected cells in breast milk: Association with immunosupression and vitamin A deficiency. Journal of Infectious Disease 1995;172:1461-1468.
Nduati R, John GC, Mbori-Ngacha DA, et al. Breast disease among lactating HIV-1 infected women. Xth ICASA. Abidjan, 1997.
Nesheim SR, Lindsay M, Sawyer MK, et al. A prospective population-based study of HIV perinatal transmission. AIDS 1994;8:1293-1298.
Newburg DS, Viscidi RP, Ruff A, Yolken RH. A human milk factor inhibits binding of human immunodeficiency virus to the CD4 receptor. Paediatric Research 1992;31:22-28.
Newell ML. Mechanisms and timing of mother-to-child transmission of HIV-1. AIDS 1998;12:831-837
Newell ML, Gray G, Bryson YJ. Prevention of mother-to-child transmission of HIV-1 infection. AIDS 1997;11 (suppl A): S165-172
Njenga S, Ombree JE, Ndinya-Achola, et al. Risk factors for postnatal mother-to-child transmission of HIV in Nairobi. Conference on Global Strategies for Prevention of HIV Transmission from Mothers to Infants, September 1997, Washington DC.
Nicoll A, Newell M-L, Van Praag E, Van de Perre P, Peckham C. Infant feeding policy and practice in the presence of HIV-1 infection. AIDS 1995;9:107-119.
Nielsen K, Boyer P, Dillon M, et al. Presence of human immunodeficiency virus type 1 and HIV-1-specific antibodies in cervicovaginal secretions of infected mothers and in the gastric aspirates of their infants. Journal of Infectious Diseases 1996;173:1001-1004.
Ometto L, Zanotto C, Maccabruni A, et. al. Viral phenotype and host-cell susceptibility to HIV-1 infection as risk factors for mother-to-child transmission. AIDS 1995;:427-434.
Orloff SL, Wallingford JC, McDougal JS. Inactivation of human immunodeficiency virus type 1 in human milk: effects of intrinsic factors in human milk and of pasteurization. Journal of Human Lactation 1993;9:13-17.
Palasanthiran P, Ziegler JB, Stewart GJ, et al. Breastfeeding during primary maternal immunodeficiency virus infection and risk of transmission from mother to infant. Journal of Infectious Disease 1993;167:441-444.
Pitt J, Brambilla D, Reichelderfer P, et al. Maternal immunologic and virologic risk factors for infant human immunodeficiency virus type 1 infection: findings from the women and infants transmission study. Journal of Infectious Disease 1997;175:57-75.
Plummer FA, Tyndall MW, Ndinya-Acholla J, Moses S. Sexual transmission of HIV and the role of sexually transmitted diseases. In: Essex M, Mboup S, Kanki PJ, Kalengayi MR. AIDS in Africa. New York: Raven Press, Ltd. , New York, 1994.
Read J. Mode of delivery and vertical transmission of HIV-1: a meta-analysis from fifteen prospective cohort studies (The International Perinatal HIV Group). XII International Conference on AIDS. Geneva, July 1998 Abstract 23603.
Rodriguez E, Mofenson L, Chang BH, et al. Association of maternal drug use during pregnancy with maternal HIV culture positivity and perinatal HIV transmission. AIDS 1996; 10: 273-282.
Roques P, Marce D, Courpotin C, et al. Correlation between HIV provirus burden and in utero transmission. AIDS 1993;7 (Supplement):S39-S43.
Rouzioux C, Costalgliola D, Burgand M, et al. Estimated timing of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission by use of a Markov model. Am J Epidemiol 1995;142:1330-1337
Ruff A, Coberly J, Halsey N, et al, Prevalence of HIV-1 DNA and P24 antigen in breast milk and correlation with maternal factors. Journal of Acquired Immune Deficiency Syndrome 1994;7:68-72.
Ryder RW , Nsuami M, Nsa W, et al. Mortality in HIV-1 seropositive women, their spouses, and their newly born children during 36 months of follow-up in Kinshasa, Zaire. AIDS 1994;8:667-672.
Ryder RW, Behets F. Reasons for wide variation in reported rates of mother-to-child transmission of HIV-1. AIDS 1994;8:1495-1497.
Ryder RW, Manzila T, Baende E, et al. Evidence from Zaire that breastfeeding by HIV seropositive mothers is not a major route for perinatal HIV-1 transmission but does decrease morbidity. AIDS 1991; 5:709-714.
Scarlatti G, Leitner T, Halapi E, et al. Comparison of variable region 3 sequences of human immunodeficiency virus type 1 from infected children with the RNA and DNA sequences of the viral population of their mothers. Proc Natl Acad Sci 1993;90:1721-1725.
Scarlatti G, Hodara V, Rossi P, et al. Transmission of human immunodeficiency virus type I (HIV-1) from mother to child correlates with viral phenotype. Virology 1993;197:624-629.
Sellon RK, Jordan HL, Kennedy-Stokskopf SK, Tompkins MB, Tompkins WAF. Feline immunodeficiency virus can be experimentally transmitted via milk during acute maternal infection. Virology 1994;8:3380-3385.
Semba RD, Miotti PG, Chiphangwi JD, et al. Maternal vitamin A deficiency and mother-to- child transmission of HIV-1. Lancet 1994;343:1593-1597.
Shaffer N, Bhiraleus P, Chinayon P, et al. High viral load predicts perinatal HIV-1 subtype E transmission, Bangkok, Thailand. XI International Conference on AIDS. Vancouver, July 1996 Abstract TuC 343.
Shearer WT, Quinn TC, LaRussa P, et al. Viral load and disease progression in infants infected with human immunodeficiency virus type 1. N Engl J Med 1997;336:1337-1342.
Simonds RJ, Steketee R, Nesheim S, et al. Impact of ziduvodine use on risk and risk factors for perinatal transmission of HIV: Perinatal AIDS Collaborative Transmission Studies. AIDS 1998;12:301-308.
Simonon A, Lepage P, Karita E, et al. An assessment of the timing of mother-to-child transmission of human immunodeficiency virus type 1 by means of polymerase chain reaction. Journal of Acquired Immune Deficiency Syndromes 1994;7:952-957.
St Louis M, Munkolenkole K, Brown C, et al. Risk for perinatal HIV-1 transmission according to maternal immunologic, virologic and placental factors. JAMA1993;269:2853-2859.
Stiehm R, Vink P. Transmission of human immunodeficiency virus infection by breastfeeding. Journal of Pediatrics 1991;118:410-12.
Taha T, Miotti P, Kumwenda N, et al. HIV infection due to breastfeeding in a cohort of babies not infected at enrolment. XII International Conference on AIDS. Geneva, July 1998 Abstract 23270.
Temmerman M, Nyong'o AO, Bwayo J, et al. Risk factors for mother-to-child transmission of human immunodeficiency virus 1 infection. Am J Obstet Gynecol 1995;172:700-705.
Thapa S, Short RV, Pott M. Breastfeeding, birth spacing and their effects on child survival. Nature 1989;335:679-682
The Working Group on Mother-to-Child Transmission of HIV. Rates of mother-to-child transmission of HIV-1 in Africa, America and Europe: Results from 13 perinatal studies. J Acquir Immune Defic Syndr Human Retrovirol 1995;8:506-510.
Thea DM, Steketee RW, Pliner V, et al. The effect of maternal viral load on the risk of perinatal transmission of HIV-1. AIDS 1997;11:437-444.
Tess BH, Rodrigues LC, Newell ML, et al. Breastfeeding, genetic, obstetric and other risk factors associated with mother-to-child transmission of HIV-1 in Sao Paulo State, Brazil. AIDS 1998a;12:513-520.
Tess BH, Rodrigues CL, Newell ML, et al. Infant feeding and risk of mother-to-child transmission of HIV-1 in Sao Paulo State, Brazil. J Acquir Immun Defic Synd 1998b;19:189-194
Thomas PA, Weedon J, Kraskinski K, et al. Maternal predictors of perinatal HIV transmission. Pediatric Infectious Disease Journal 1994;13:489-495.
Tovo PA, De Martino M, Caramia G, et al. Epidemiology, clinical features, and prognostic factors of paediatric HIV infection. Lancet 1988; ii:1043 -1046.
UNAIDS. Report on the Global HIV/AIDS epidemic. Geneva: UNAIDS, 1998.
UNDP. Young women: silence, susceptibility and the HIV epidemic. (Editorial) Paediatric AIDS and HIV infection: fetus to adolescent 1994;5:1-9.
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.
Van de Perre P, Simonon A, Hitimana D, et al. Infective and anti-infective properties of breastmilk from HIV-1-infected women. Lancet 1993;341:914-918.
Van de Perre P, Hitimana DG, Simonan A, et al. Postnatal transmission of HIV-1 associated with breast abscess. Lancet 1992;339:1490-1491
Van de Perre P, Meda N, Cartoux M, Leroy V, Dabis F. Late postnatal transmission of HIV-1 and early weaning. Lancet 1997;350(9072):221.
Victora CG, Vaughan JP, Lombardi C, Fuchs SM, Gigante LP, Smith PG, Nobre LC, Teixeira AMB, Moreira LB, Barros, FC. Evidence for protection by breastfeeding against infant deaths from infectious diseases in Brazil. The Lancet 1987 (ii): 319-322.
Villari P, Spino C, Chalmers TC, et al. Caesarian section to reduce perinatal transmission of human immunodeficiency virus. On-line J Curr Clin Trials 1993;2:July 8 Document no. 4.
Wabire-Mangen F, Gray RH, Mmiro FA, et al. Placental risk factors for the vertical transmission of HIV-1 in Uganda. XI International Conference on AIDS. Vancouver, July 1996 Abstract TuC341.
World Development Report: Investing in health. World Development Report, Oxford University Press. 1993.
Wortley PM, Fleming PL. AIDS in women in the United States, recent trends. JAMA 1997;278:911-916.
Ziegler JB, Johnson RO, Cooper D, Gold J. Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet 1985;i:896-898.
Zollner B, Feucht H-H, Helling-Giese G, et al. Threshold of HIV-1 copy numbers for vertical transmission. AIDS 1997;11:542-3.