Gonneke you wrote,

"One sentence caught my eye (but I didn't readfurther, for I was looking for
something else), saying that transmissionthrough breastfeeding was higher
when the HIV+ mom had cracked nipples or mastitis.That made me realise that
it is not the milk that is the most "dangerous" forthe child, but the
breastfeeding circumstances."

Semba et al. did some of the studies on mastitis and hiv transmission that
are the basis for the belief that mastitis carries a higher risk of hiv
transmission.  If my recall is correct he based his findings on breastmilk
samples that were frozen and 2 years old.  So how did he find the virus in
those samples and how were they correlated to cases of  mastitis. Most of the
studies that we are basing policy on were done with hiv tests that are now
considered highly inaccurate. (ELISA/Western Blot)  Even PCR is considered
inaccurate in the first month of an infant's life (50% false positives).

What is dangerous circumstances?  Breastfeeding?  Are we basing our concerns
on hiv transmission alone as being dangerous?  What about infant health
incomes? What I believe we have to ask ourselves, is how the researchers were
able to correlate these findings.  One accepts these statements as fact but
if they are based on studies using human milk samples, how accurate are they?
 Are we saying that the intrinsic factors no longer work during bouts of
mastitis and sore nipples?  Or are we saying that only in hiv positive
mothers do the intrinsic factors not work. Do we know this?  Has this been
proved?  I don't think so.
Valerie W. McClain, IBCLC





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