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5422849 
Journal Article 
Review 
Transmission of human immunodeficiency virus type 1 through breast-feeding: how can it be prevented? 
Van de Perre, P 
1999 
Yes 
Journal of Infectious Diseases
ISSN: 0022-1899
EISSN: 1537-6613 
179 Suppl 3 
S405-S407 
English 
10099107 
WOS:000079973300005 
One-third to two-thirds of maternal transmission of human immunodeficiency virus type 1 (HIV-1) infection to breast-fed infants can be attributed to ingestion of breast milk. The presence of HIV-1 as cell-free and as cell-associated virus in milk has been documented. Several substances in breast milk may be protective against transmission, including maternal anti-HIV antibodies, vitamin A, lactoferrin, and secretory leukocyte protease inhibitor. The portal of virus entry in the infant's gastrointestinal tract is unknown but may involve breaches in mucosal surfaces, transport across M cells, or direct infection of other epithelial cells, such as enterocytes. Timing of transmission of HIV-1 during lactation should be further clarified. An early rebound of plasma viremia after withdrawal of antiretrovirals was recently detected. This rebound may reduce the benefit of antiretroviral prophylaxis when women breast-feed their infants. Interventions should be viewed from the public health perspective of risks of infant morbidity and mortality associated with breast-feeding versus risks from formula-feeding.