liminated from breast milk at a slower rate than in plasma. HIV viral load in breast milk was not significantly different among women who were partially or fully compliant to HAART.

Notably, this study found that in untreated women, the concentration of HIV RNA in breast milk was higher than was the case in other studies. The authors suggest that this could be a result of greater sensitivity in the processing of specimens, without ruling out the possibility that results might also be affected by variation in CD4 cell values in different populations. They did not find a higher than expected NVP plasma level in this group of women as was the case in a previous Malawian study.

Both HAART administration and CD4 cell count were independently associated with levels <50 copies/mL in breast milk at day 7, and in untreated women, there was a higher rate of detectable HIV DNA in breast milk cells (55% versus 32.5% in group A, p=0.07). In contrast to other studies though, the effect of HAART on DNA levels was lower than its effect on HIV RNA levels.

These results suggest that this particular ARV regimen, given during and after pregnancy, is able to significantly reduce HIV RNA viral load in both plasma and breast milk and suggest there may be a role for maternal HAART prophylaxis as a means to reduce breastfeeding-associated transmission.

No mention of hypersensitivity reactions was made although some of the women given NVP had CD4 cell counts above 250 cells/mm3, implying a higher risk of hypersensitivity reaction. The small sample size of this pilot study may have limited results in this area. In regard to future virologic studies of breast milk, a recommendation was made to use whole milk, as it showed an equal sensitivity to skim milk, a greater sensitivity than the lipid layer, and processing is not required. The authors also point out a need for longer-term postpartum ARV pharmacokinetic studies and further data on the infa
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