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August 23/30, 2000

Breastfeeding in Women With HIV—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(8):956-957. doi:10.1001/jama.284.8.956

In Reply: Dr Bulterys raises concern about comparability of the 2 arms of our trial because of the differential HIV-1 infection rates at birth. The most likely explanation was low specificity of the HIV-1 poymerase chain reaction test on cord blood combined with a high risk of breast milk transmission during the first 6 weeks of life (the next scheduled testing time). The likelihood that a positive test at birth would be followed by a second positive test result was higher in the breastfeeding arm than the formula arm (50% vs 18%) because of ongoing exposure to HIV-1 through breastfeeding. The timing for such infections was defined by the first positive result (even though the cord blood result may have been a false positive), hence a higher apparent infection rate at birth. We developed statistical methods to adjust for this problem.

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