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Subject:
From:
"Valerie W, McClain" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 8 Jun 2004 06:50:27 EDT
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Kate,

This is a factsheet from the NIH on HIV infection in women, under the
subtitle MTCT (mother to child transmission) dated May 2004...
http://www.niaid.nih.gov/factsheets/womenhiv.htm
"Most MTCT, an estimated 50 to 70 percent, probably occurs late in pregnancy
or during birth. Although the exact ways the virus is transmitted are unknown,
scientists think it may happen when the mother's blood enters fetal
circulation or by mucosal exposure to the virus during labor and delivery."
Most documents/research state that most transmission is during pregnancy and
delivery.  The belief and policy that transmission occurs during breastfeeding
(14% is the common number used based on Dunn et al. 1992) is predicated on
research done in the late 80's and early 90's.  Yet the testing used back then
to determine a baby's hiv status is no longer considered acceptable for
infant's under 18 months (ELISA and Western Blot).  PCR testing which is the current
standard in infants gives alot of false positives in the first month.  Thus
the recommendation is to test after the first month to get an accurate reading
and then to test a second time at a later date to confirm that positive.
HIV/AIDS prevalence is highest in the following states:  New York,
California, and Florida.  In the year 2002 Florida had the highest number of pediatric
AIDS cases in the USA--37.  In that year we had 205,580 live births. But the
number of newly diagnosed AIDS cases in children in Florida has declined 92
percent since 1992. (from Florida Senate Staff Analysis and Economic Impact
Statement) So in your state--Colorado, what kind of exposure is likely?  How many
infants of hiv positive mothers in Florida would we believe are being breastfed?
 I would suggest that in all probability not one.  Breastfeeding is not
recommended in the USA by the CDC and I believe all health care facilities would
reinforce that recommendation.  In fact we know that hiv positive women have
been made to formula feed their infants because of the threat of losing their
parental rights.  I would suggest that the probability of this child care
facility having a hiv-infected mother who is breastfeeding her baby to be virtually
zero.
The CDC states that universal precautions do not apply to human milk, unless
someone is handling alot of human milk such as in human milk banking. see
(bottom of document) http://www.cdc.gov/ncidod/hip/blood/universa.htm
Have you seen the OSHA book and what it states?  If the OSHA book has this
statement, then I would think they need to be queried on how they developed this
statement.
Valerie W. McClain, IBCLC

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