• Olivier Manigart, Montcho Crepin, Valeriane Leroy, Nicolas Meda, Diane Valea, Edward N Janoff, Francois Rouet, Laurence Dequae-Merchadoux, Francois Dabis, Christine Rouzioux, Philippe Van de Perre, and Diminution de la Transmission Mere-Enfant Study Group.
• Centre MURAZ, 01BP390 Bobo-Dioulasso, Burkina Faso, Cote d'Ivoire.
• J. Infect. Dis. 2004 Oct 15; 190 (8): 1422-8.

AbstractPerinatal zidovudine (ZDV) prophylaxis decreases rates of perinatal transmission of human immunodeficiency virus type 1 (HIV-1). Its relationship with levels of HIV-1 RNA in breast milk and postnatal transmission in breast-fed African children is unknown. At day 8 after delivery, levels of HIV-1 RNA in breast milk from 28 women who transmitted HIV-1 (Ts) postnatally and from 130 women who did not transmit HIV-1 (NTs) were lower for women receiving ZDV than for women receiving placebo. Levels of HIV-1 RNA in breast milk remained low over time in NTs but increased by 8-16-fold in Ts treated with ZDV from baseline to days 45/90 after delivery. Levels of HIV-1 RNA in breast milk at day 8 after delivery and the increase in levels of HIV-1 RNA in breast milk from day 8 to days 45/90 after delivery were independently associated with postnatal transmission. An increase in the levels of HIV-1 RNA in breast milk from day 8 to 45 after delivery was associated with maternal ZDV prophylaxis. The rebound in levels of HIV-1 RNA in breast milk after discontinuation of maternal antiretrovirals needs to be further explored--it may justify prolonging antiretroviral prophylaxis during the entire breast-feeding period.Copyright 2004 Infectious Diseases Society of America

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