This is a tough one, but let's look at things rationally.  Will a week
really increase the risk that much?  Do we know that breastfeeding
increases the risk of transferring HIV?  We do not, and the risk from
breastfeeding is not known to be elevated, if the mother was infected
way back in April and is not symptomatic.  There is definitely a risk if
the mother is infected while nursing or is sick, but not in this
situation even if she were positive.  But she may not be positive.  If
she can stand the stress, I would say keep breastfeeding.

Now, about the US.  The WHO recommendation is *not* that HIV positive
women in the US not breastfeed.  The recommendation is that if the risk
to the baby is greater from breastfeeding, the mother should not
breastfeed, but if the risk to the baby is greater from formula feeding,
then the mother should breastfeed.  Thus, it may be better for an HIV
positive woman in Nigeria who can pay for formula, who has access to
clean water and the other things necessary for safe formula feeding to
not breastfeed, while an HIV positive First Nations mother on Vancouver
Island (that's Canada, but we're *almost* as well off as the US), where
the infant mortality is 4 times greater than the surrounding white
population (and almost all the excess mortality is caused by illnesses
that can be prevented by breastfeeding), might be better to breastfeed.

Jack Newman, MD, FRCPC