Current or prospective research into mothertochild transmission

The main current public-health research question is whether breastfeeding by HIV-infected mothers can be made safer as to transmission risk, given the possible adverse effects of refraining from breastfeeding. Various ongoing or planned trials and studies concern either mode of infant feeding (exclusive or mixed) or antiretroviral therapy to either the mother or the infant over the breastfeeding period. Other related topics on which research is under way or planned are the mechanisms of...

Infant feeding options designed to prevent mothertochild transmission

The infant feeding options designed to prevent mother-to-child transmission are described in detail in other documents (WHO UNICEF UNFPA UNAIDS, 2003a and b). Several investigators have attempted to use mathematical models to guide policymakers in weighing the relative risks and benefits of breastfeeding and other infant feeding options in this context (Nagelkerke et al., 1995 Nicoll et al., 2000). These models are limited by the scarcity of data on the risks associated with various methods of...

Integrity of mucous membranes

Conditions that damage the mucous membrane of infants, such as oral thrush (Candida infection), may be associated with an increased risk of transmission through breastfeeding. It is difficult, however, to determine which is cause and which effect, since thrush may be a feature of early HIV-1 infection (Ekpini et al., 1997 Embree et al., 2000). Infant oral thrush can also cause nipple thrush and fissures. Damage to the intestinal mucous membrane can result from feeding with cow's milk, allergic...

Mechanisms of breastfeeding transmission

Although HIV has been detected in breast milk (Nduati et al., 1995 Ruff et al., 1994 Van de Perre et al., 1993), mechanisms of transmission through breastfeeding remain incompletely understood. Not yet reliably quantified are the respective roles of cell-free and cell-associated virus in transmission through breastfeeding or the association between virus levels in plasma and milk. The portal of entry for the virus via the infant mucosa also merits further investigation animal models have shed...