Kristen,
Alot of research done in the 90's on breastfeeding and hiv transmission did
not use the current recommendation for diagnosing hiv in infants.  I take the
current recommendation from a Baylor College of Medicine Hiv Nursing
Curriculum (2001).
They say, "Because maternal antibodies can be detected in an infant's blood
for up to 18 months after birth, the ELISA and Western blot serum tests will
be positive, regardless of whether the infant is infected.  These tests will
be positive, regardless of whether the infant is infected.  The most specific
way to diagnose HIV infection in an infant is by PCR for HIV DNA [or HIV
culture--very expensive and time-consuming]....If using PCR techniques, the
infant needs to have two positive PCR serum tests taken at two separate times
to be considered infected."  They go on to say that the first PCR should be
performed after one month of age. (because it has a 50% chance of creating a
false positive in the first month).

The Mbori-Ngatcha et al paper was from research done from 1992-1997 (same
massive research data as Nduati et al).  I believe they did not follow the
above criteria for testing of infants.  Therefore, I believe that their
results are not accurate.  This also means that the Nduati et al studies are
not accurate.  Determining the status of the infant in the early months is
difficult because of maternal antibodies.  When testing an infant younger
than a month old, all you are really determining is the mother's status not
the infant's.  As far as I am concerned most of the research done on hiv
transmission and breastfeeding is questionable.  It seems highly likely that
most if not all hiv transmission (if you believe that hiv exists) occurrs
during pregnancy and birth.

Newell does not suggest that breastfeeding heightens the  mortality among
mothers.  I would suggest you reread her commentary in the Lancet in regard
to the Nduati et al paper.  What she does say is:

"Except possibly in cases of advanced HIV disease, there seems no reason why
breastfeeding should increase the risk of death for HIV-infected women.
Since only an intention-to-treat analysis is presented here, the findings are
difficult to interpret.  If, as is implied, women in this trial were
undernourished, questions should be raised about the ethics of a research
programme without due care of the mothers."

There are no safe alternatives to breastfeeding for HIV-1 infected women in
low resource settings.  According to a patent on human milk components,
rotavirus in the USA killed 500 infants in 1997.  Rotavirus is one of two
viruses that human milk inactivates both in vivo and in vitro (polio is the
other).  Human milk components are being either used or imitated by the drug
and infant formula industry to inactivate rotavirus (HMFG is the component
stated in a John Hopkins patent).  We protect an infant in developed nations
from hiv infection (which does not necessarily mean that the infant is sick,
just that they have the antibodies) by denying them access to breastmilk that
would protect them from diarrhea. Infant formula can cause rapid dehydration
during diarrhea episodes because of its high solute load.  If an hiv positive
infant dies from the rapid dehydration/diarrhea caused by infant formula, do
we believe that it is hiv/aids that killed the infant or rotovirus that could
have been prevented by exclusive breastfeeding?  Valerie W. McClain, IBCLC

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html