To the Editor: The study by Dr Nduati and colleagues1 confirms observations from nonrandomized studies
that breastfeeding (irrespective of duration or exclusivity) increases the
risk of HIV-1 transmission. The study is uninformative about other dimensions
of breastfeeding transmission such as weaning practices and the duration of
breastfeeding. Since the authors did not collect detailed information on breastfeeding
practices (eg, whether the infant received water), the appropriate definition
of exclusive breastfeeding cannot be applied to these data. Exclusive breastfeeding
in Kenya is rare: surveys estimate rates from 0% to 17%.2
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