I've been no-mail for a while, and have missed you all. I don't know if
I'm going to be able to stay "latched-on" long because of an amazing
amount of work....but have been very fascinated by this discussion.
I don't claim to be any kind of expert, but have just done a literature
review for an upcoming talk, and have come to the following conclusions
about HIV and breastfeeeding:
Breastfeeding does sometimes transmit HIV, but the exact amount is
difficult to quantify because most of the studies are epidemiologic and
include all perinatal transmission. (e.g. 25% of babies who weren't
breastfed got HIV, 30% of those who were breastfed got HIV, but not a lot
of info about any differences among the mothers or babies in the two
groups or about duration or exclusivity of breastfeeding.)
HIV positive babies do best if they receive breastmilk, especially milk
from their own mothers.
The risk of HIV transmission goes up when mom's viral load is higher:
primary infection during breastfeeding or end-stage AIDS; it also seems to
go up with longer duration but that may reflect advancing maternal
disease. There is some suggestion that there is less risk with exclusive
breastfeeding than with mixed feeds, possibly due to gut integrity, but
this is VERY speculative and preliminary.
Moms with AIDS get sicker if they breastfeed longer than 6 months.
We need a good "instant" test for HIV in newborns. PCR is a good first
step, but not "instant".
We would prevent a lot more childhood AIDS globally if we focused our
efforts and $$ on preventing women from getting infected in the first
place, rather than worrying about providing formula for babies of HIV
positive mothers.
We need LOTS more study of a lot of things related to breastfeeding and
HIV, but since we have this wonderful "safe" alternative and breastfeeding
doesn't really matter, particularly in the US and Europe, and the formula
companies are being such good global citizens by helping to provide
formula for babies of HIV positive mothers (sigh), we probably will never
get all the research we need to answer all of these questions
definitively.
--
Anne Montgomery, M.D., I.B.C.L.C.
mailto:[log in to unmask]
St.Peter Hospital Family Practice Residency
Olympia, WA, USA
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