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Breastfeeding in Women With HIV
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To the Editor: Dr Nduati and colleagues1 present evidence to support the importance of very early postnatal human immunodeficiency virus type 1 (HIV-1) transmission through breastfeeding. However, differences between the trial arms in HIV-1 infection rates at birth and soon after raise a potential source of bias. Randomization to breastfeed or formula feed at 32 weeks of pregnancy may have led to differences in behavioral or biological risk factors for intrapartum or late prenatal HIV-1 transmission.2-3 Women with HIV-1 who agreed to be randomized and were assigned to the formula feeding arm (213/2315 = 9% of the entire sample of HIV-1–seropositive women) received free formula and instruction sessions in late pregnancy on boiling water and minimizing bacterial contamination.
While crucial to the ethical conduct of the trial, this intervention may have resulted in differences between the groups by the time of labor and delivery, when most vertical HIV-1 transmission is . . . [Full Text of this Article]
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