No one replied that this had appeared on Lactnet, so I am posting it.  Has
anyone seen this issue of Lancet yet?  This came from Ted Greiner.

 Subject:     First evidence that exclusive breastfeeding does not transmit
HIV
    Date:      Sat, 7 Aug 1999 00:58:28 +0200


 Finally a prospective study has done on mother-to-child transmission of
 HIV through breast milk using the correct definition for exclusive
 breastfeeding. The study concluded that when breastfeeding is exclusive
 the entire time from birth, it does not appear to transmit HIV from an
 HIV-positive mother to an HIV-negative baby.

 The paper is entitled "Influence of infant feeding patterns on early
 mother-to-child transmission of HIV-1 in Durban, South Africa: a
 prospective cohort study" and is published in the August 7, 1999 issue
 of the medical journal Lancet. the authors, A. Coutsoudis et al., found
 that transmission rates among those who were exclusively breast fed from
 birth were actually lower at three months than among those not breast
 fed at all, and much lower than those breast fed but not exclusively.
 Though the difference was not statistically significant for those not
 breast fed at all, the authors write that this "raises a possibility
 that virus acquired during delivery could have been neutralised by
 immune factors present in breastmilk but not in formula feeds."

 In any case, infants who were non-exclusively breast fed (receiving
 water, tea, juice, milk, solids or other things in addition to breast
 milk) suffered statistically higher rates of early postnatal
 transmission of HIV. The most likely explanation for this is that
 anything except breast milk can damage the lining of the infant's
 alimentary tract in various ways. The authors point out that "once the
 integrity of mucosal surfaces has been compromised by infection,
 allergens or trauma, the passage of HIV-1 across mucous membranes into
 body tissues is facilitated."

 Obviously more studies are needed, but I see two implications that
 emerge
 already and should be given serious consideration by UNAIDS/WHO/UNICEF
 in
 their continued implementation of their new guidelines on HIV and
 breastfeeding:

 1. In ongoing counselling and pilot testing in poorer areas, much more
 emphasis should be placed on an option that so far has received little
 attention: exclusive breastfeeding for a few months followed by either
 heat treatment of expressed breast milk or rapid cessation of
 breastfeeding. Relative risks for morbidity and mortality among infants
 not breast fed are much greater in these first months. After a few
 months, it is much easier for the child to do relatively well on
 homemade formulas or other substitutes more affordable to poorer
 families, and the child can better tolerate solid foods.

 Also, research should be done to determine what rates of transmission
 occur
 among women who continue breastfeeding with solid foods after varying
 periods of exclusive breastfeeding. For example, after six months or
 longer
 or exclusive breastfeeding, the child may better be able to tolerate
 other
 foods and resist infection and thus less gut mucosal injury and
 disruption
 of immune barriers may occur.

 2. The best way to reduce overall rates of postnatal mother-to-child
 transmission of HIV in developing countries is to promote exclusive
 breastfeeding from
 birth for all newborns. Most women who are HIV positive during pregnancy
 do not know it and this is not likely to change for a long time in many
 countries, for both cultural and economic reasons.

 The same issue of Lancet also contains a commentary on this article by
 M-L Newell who believes that "further research is urgently needed to
 confirm and elucidate the findings" before changing public health
 recommendations, but calls for a "re-evaluation of the role of
 breastfeeding in the transmission of HIV-1."

 Sadly, we have no agreed-upon indicator to tell us how many infants are
 "exclusively breast-fed from birth." This is needed to inform policy
 makers on the current situation and as a baseline to judge the success
 of promotional efforts.

 Such an indicator would be easy to obtain data on. In any breastfeeding
 survey, whenever a mother says she gave nothing but breastmilk to her
 baby in the past 24 hours, the interviewer would ask, "Have you EVER
 given anything besides breast milk?"

 I recently corresponded with the person responsible for developing the
 breastfeeding component of the new Demographic and Health Survey
 questionnaire about adding it. Unfortunately, she would not agree to use
 it, partly out of fear that the resulting figure would be so low that it
 might discourage policy makers from trying to do anything about it.

 With best regards,
 Ted Greiner
 Coordinator
 World Alliance for Breastfeeding Action (WABA) Research Task Force
 WABA website: http://www.waba.org.br
 Personal website: http://www.welcome.to/breastfeeding
  ________________________

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