The use of option B+ in prevention of mother to child transmission of HIV infection programs

through implementation of option B+ would have various other benefits. The total fertility rate in Malawi is high, around five to six births per woman, which is unlikely to be much lower in HIV‑infected women. Soon after the breastfeeding period (median duration 23 months) many women become pregnant again. Thus, a stop‑start approach to ART administration is almost redundant. Many women present for antenatal care late in pregnancy—an estimated 50% are thought to attend after 28 weeks of gestation—and continuing prophylaxis with antiretroviral drugs would mean that the next pregnancy could be protected from conception. The stopping of ART after cessation of breastfeeding might lead to viral rebound, with the risk of transmission to a sexual partner or fetus being notably raised. In women in Zimbabwe even those with CD4 cell counts higher than 350 cells per μL had a risk of death around six times higher than that in noninfected women within 24 months post‑partum [2,3] , and early ART could reduce mortality by 50‑90%. [4] Prevention