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November 20, 1996

Preventing Perinatal Transmission of HIV: The Effect of Breast-feeding-Reply

Author Affiliations

Centers for Disease Control and Prevention Atlanta, Ga

JAMA. 1996;276(19):1552-1553. doi:10.1001/jama.1996.03540190024019

In Reply.  —As Drs Nicoll and Newell suggest, short-course zidovudine treatment to reduce mother-to-child transmission of HIV may not be cost-effective in all settings. However, according to our model, such treatment (if shown to be efficacious) may be cost-effective from a societal perspective across a wide range of per capita gross national products, particularly in areas with high HIV prevalence among childbearing women. Considerations for its use in particular settings will depend on the relative importance of HIV prevention among other health needs.We share the concern that increased postnatal HIV transmission in breast-feeding populations could offset some of the benefit achieved by prenatal and perinatal HIV transmission prevention with zidovudine or other strategies. Our model adjusts the number of children at risk for postpartum HIV infection based on changes in prenatal and perinatal HIV transmission rates. For example, in a population in which 100% of the infants are breast-fed with a