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The use of peripartum antiretroviral prophylaxis to reduce mother-to-child HIV transmission has been one of the biggest triumphs in HIV control. Unfortunately, infants who are protected from intranatal infection can still acquire the virus by breast-feeding, and, after more than a decade of research, few simple solutions are available to address this problem in developing countries. Two large studies now examine different approaches.
In Malawi, investigators conducted a randomized trial of extended prophylaxis among more than 3000 neonates who were born HIV-negative to HIV-positive mothers. All infants received a single dose of nevirapine and 1 week of AZT prophylaxis. Infants in the intervention groups then received a 13-week course of nevi…