5 fold (95CI 1.3 to 4.8) greater risk of HIV infection or death at 18 months [45]. Breast milk protective mechanisms include factors that have the ability to inactivate HIV and/or binding to the infant mucosa and/or target cells. Milk also contains many anti-inflammatory factors that would limit viral replication within milk, as well as maintain the integrity of both mainly the mammary (reducing transmissibility) and the infant mucosal epithelia (reducing susceptibility) [46]. The WHO infant feeding guidelines in the context of HIV have been revised to ensure balance between HIV prevention with protection from other causes of child mortality. They recommend that national or subnational authorities should decide whether health services will principally counsel and support HIV infected mothers to either avoid all breastfeeding or to breastfeed and receive infant or maternal antiretroviral prophylaxis [43].

In Rwandan general population, exclusive breastfeeding is the norm. As reported by Rwanda Demographic and Health Survey 2010 results, eighty-five percent of children under age of 6 months are exclusively breastfed, 2 percent are given milk and plain water, 7 percent get breast milk and non-milk liquids, and 3 percent take other types of milk in addition to breast milk [6]. With regard to mixed feeding in the context of HIV/AIDS in Rwanda, an evaluation of infant feeding and young child feeding practices reported high prevalence of exclusive breastfeeding with weaning at 4�C6 months. The author found no indication that mothers who mixed fed did so because they believed their breast milk was insufficient.

This finding suggest that it should be possible to achieve even higher rates of exclusive breastfeeding if mothers are educated about the need to avoid feeds other than breast milk and, if they are supported, to have faith that their milk is adequate for their babies, even if their health and nutritional status are less than ideal [44]. CD4 count Maternal CD4+ count has been used as an indicator to assess eligibility for antiretroviral treatment & prophylaxis for prevention of HIV-1 mother-to-child transmission and low CD4+ lymphocyte count was found associated with increased mother-to-child transmission risk [47-53]. Available studies have also shown that CD4 count increases with the use of triple-drug combination therapy [54].

Hemoglobin Studies conducted in Sub-Saharan Africa that have found low maternal hemoglobin level (<11 g/dl) during pregnancy, AV-951 as a risk factor for HIV-1 mother- to-child transmission [55-57]. Anemia is a common clinical finding in HIV-infected patients. In these patients, many factors may contribute to the development of anemia, including nutritional deficiencies, opportunistic infections, AIDS-related malignancies, drug treatment and a direct effect of HIV on the bone marrow.