Re Jan Barger's question about proven HIV transmission. At the first WHO
expert meeting on the subject several years ago, the only "proven" cases
were several women in France, Australia and Rwanda who had received
transfusions at or after delivery with blood later shown to be infected and
whose babies then got infected but whose husbands were not. These women
were otherwise not thought to be risk cases and thus it was assumed they
were not infected before pregnancy, though in no cases were there
prepregnancy blood tests to prove this. I got the expert group to agree to
add a sentence to the WHO statement pointing out that it was likely that if
breast milk did transmit HIV, it was much more likely when the mother was
undergoing the primary infection a few weeks after herself contracting the
infection (likely to be uncommon during breastfeeding now, since most blood
for transfusion is tested and few go out and start having risky sex while
breastfeeding). Later research has borne this out and that aspect was
strengthened in the second WHO statement on HIV and breastfeeding. (The
other time when the risk of transmission via breast milk is high is during
active AIDS, when blood levels of HIV are again high.)

A couple years ago I was at another breastfeeding meeting at WHO when the
following points were raised (a lot can be said by WHO in meetings but not
published, since politics then enters the equation):

1) In countries where the infant mortality rate is over 50 per 1000 live
births, the effect of advising mothers with HIV (and rarely in such
countries do women know) not to breast feed will be to increase infant
mortality.

2) There is (or was at that time) no evidence that breast milk can infect a
healthy baby with an intact mucosal lining in the mouth and GI tract.
Perhaps the most important public health message in countries where HIV is
common is to avoid gavage in newborns. I'm not sure about this, but
apparently in some countries they still routinely mess around trying to
suck out stuff from the mouth of the baby after birth and may damage the
oral mucosa in such a way as to allow HIV virus to penetrate.

Ted Greiner, PhD
Senior Lecturer in International Nutrition
Unit for International Child Health, Entrance 11
Uppsala Universityen

phone +46 - 18 515198
fax   +46 - 18 515380

home phone +46 - 8 191397 (can be used as fax also)