Dear Chris

In regard to the recommendation that mothers with, or at risk of HIV, should
exclusively breasfeed their infants:

> Dr. Coovadia said he thinks one solution may be to encourage infected women
> to breast-feed exclusively for at least six months after giving birth. That
> is because another study presented this week suggested that babies given
> breast milk exclusively from their infected mothers didn't get infected at
> high rates.
>
there is a study that indirectly, I believe, supports this assertion. This
study investigated whether there was possible infant gut damage from pro
inflammatory milk cytokines present in mastitic breastmilk. A
lactulose/mannitol test was used to assess increased infant gut
permeability. They found no relationship between sodium:potassium ratio or
Interleukin-8 (an inflammatory cytokine) with increased gut permeability
however they DID find that infants who received mixed feeding, as opposed to
to exclusive breasfeeding, had an increase in gut permeability. Although
this was not a conclusion of the study, it would seem to me that, such an
increase in permeability where infants were not exclusively breastfed would
increase the risk of transmission where there were high viral loads present
in breastmilk. The reference is:
Willumsen, JF., Filteau, SM., et al., 1999. Subclinical mastitis as a risk
factor for mother-infant HIV transmission. Proceedings of 9th International
Conference of the International Society for Research in Human Milk and
Lactation )18. kloster Irsee, Germany. (although has probably published in a
journal since then)

Cathy Fetherston RM MSc IBCLC
Perth, Western Australia

>>

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