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.
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