On 10/2/03 3:12 AM, "Automatic digest processor"
<[log in to unmask]> wrote:

> 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.

The high HIV load in milk found by Semba in what he called mastitis was in
fact only "mastitis" diagnosed by the level of sodium in the milk rather
symptoms experienced by the mother. This is the first error of assumption.
High sodium levels can of course be caused by other breastfeeding situations
such as mixed feeding during weaning, and perhaps in other "breast
conditions" which haven't yet been described in the literature.

 However if the sodium is high in milk (whatever the cause) we assume the
paracellular pathway is open - which is probably the reason for the
increased viral load identified in milk. The second error of assumption made
was that a high viral load in milk is the reason for the increased HIV
transmission to the neonate.

Interestingly Willumsen (1999) did a study postulating that the increased
HIV transmission seen in "mastitis"  was due to the pro-inflammatory
cytokines present in mastitic milk, which when transmitted to the infant
would cause increased permeability of the infant gut - thus increasing
infection rates. But what they actually found was that, where there was
increased pro inflammatory milk cytokines (and exclusive breastfeeding),
there was no disruption of gut permeability - but guess what did increase
gut permeability - mixed feeding! The danger is not directly from the
increased viral load during increased paracellular permeability - but is
where there is an increased viral load in the milk and a baby that is not
being exclusively breastfed.

Cathy Fetherston CM MSc IBCLC
Perth, Western Australia

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