Jennifer you wrote, "It is believed that breastfeeding results
in an increased rate of transmission (and there are cases where HIV
transmission is known to have occurred through breastfeeding; cases where
baby was negative after birth, then converted later on.)   Since we don't
know which infants are infected (accurate testing can be done at 1 month of
age,) or which will be infected via breastfeeding, that's why the
recommendation that no infant with an HIV positive mom in an industrialized
country be breastfed."

Since we don't know which infants are infected at birth, how can we state
that the cause of late seroconversion by an infant is caused by
breastfeeding?  At birth the status of the infant is unknown, even the PCR is
considered unreliable until an infant is one month of age.

The 1985 CDC policy of discouraging breastfeeding for hiv-positive mothers
was based on 2 letters written to the Lancet.  These two letters (Zieglar and
Thiry) total 4 cases.  ELISA and Western Blot tests were used.  Colebunders
is another letter to the Lancet which suggests that hiv is transmitted by
breastmilk and the ELISA and Western Blot was used.  These tests are no
longer considered accurate in determining hiv status in infants.  Yet the
basis for our policies on breastfeeding and hiv used these tests.  Has this
issue been revisited, since those tests are no longer considered accurate?
Or are we accepting policy based on erronous testing?  And how can the
testing of human milk for hiv be done, if the intrinsic factors inactivate
the virus?

Actually, as Magda has posted:  the important issue is not so much hiv
transmission as infant health outcomes. If we save an infant from hiv transm
ission by not allowing breastfeeding but that infant dies from dehydration
from diarrhea due to infant formula feeding or succumbs to enterobacter
sakazakii because of infant formula contamination, what have we truly gained?
 Valerie W. McClain, IBCLC

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