Mary

There have been a few case reports of HIV-infected babies 
transmitting HIV to non-infected mothers.  I'll copy a couple of the 
abstracts below - these are probably the ones that Karleen already 
sent links to:

---------------------------------------------------
 From IAC 2006 Toronto Conference Abstract
Child-to-mother transmission of HIV by breastfeeding during the 
epidemic in Benghazi, Libya, B Longo, G Liuzzi, V Tozzi, G Anzidei, M 
A Budabbus, O A Eljhawi, M I Mehabresh, A Antinori, E Girardi, U 
Visco-Comandini

Background: In the HIV-1 epidemic that occurred in the Benghazi 
Children Hospital in Libya in 1998-99, at least 402 children and 20 
mothers were infected by a monophyletic CRF2-AG strain. The children 
had clearly acquired the infection through nosocomial transmission. 
The objective of this study was to determine the transmission 
modality for the mothers.
Methods: We considered the child-mother pairs involved in the 
epidemic as concordant if both the mother and child were HIV-positive 
and as discordant if only the child was HIV-positive. Epidemiological 
data on the children, with particular focus on the duration of 
breastfeeding in relation to hospitalization periods, were 
retrospectively collected by directly interviewing the mothers at our 
Institution in Rome, where Libyan HIV-infected patients underwent 
clinical follow-up in 2001.
Results: Of the 104 pairs, 20 were concordant and 84 discordant. In 
all of the children and in 5 of the 20 infected mothers, an 
intravenous treatment or a needle-stick injury during the epidemic 
was documented. Information on breastfeeding was available for 92 
pairs. Breastfeeding during or after the child's hospitalisation was 
reported by 87.5% of the HIV-infected mothers and 30.3% of the 
HIV-negative mothers (OR 16.13; 95%CI 3.20-152.64). This association 
remained significant after excluding from the analysis the 5 mothers 
who reported a possible at-risk parenteral exposure (OR 23.04; 95%CI 
2.87-1018.9). All of the 61 fathers tested for HIV were negative. 
When repeating the analysis only on the pairs with an HIV-negative 
father (n=56), so as to exclude the possibility of sexually 
transmitted infection, the association between the mother's 
serostatus and breastfeeding during hospitalisation remained 
significant (OR 12.76; 95%CI 1.38-593).
Conclusions: These results support the hypotheses that HIV can be 
acquired by breastfeeding an infected child, which could be of 
particularly great concern in countries where wet-nursing is common.
-------------------------------
Zh Mikrobiol Epidemiol Immunobiol. 1990 Apr;(4):17-23.

[An intrahospital outbreak of HIV infection in Elista]

[Article in Russian]

Pokrovskii VV, Eramova IIu, Deulina MO, Lipetikov VV, Iashkulov KB,
Sliusareva LA, Chemizova NM, Savchenko SP.

For the first time a nosocomial focus of HIV infection was established.
Out of 83,000 inhabitants of the Kalmyck ASSR who underwent planned
examination in the course of epidemiological investigation, 65 cases of
HIV infection were detected and all of them were traced to the focus of
hospital infection (56 children and 9 adults: 1 man and 8 women; of these,
7 women contacted the infection from their infected children in the
process of breast feeding). The children were infected during their stay
in two hospitals of Elista where they received multiple intravenous and
intramuscular injections. The infection spread from the infant department
of the regional pediatric hospital to 4 more departments and to the
infectious diseases hospital. Transmission of this infection was
maintained for several months by the use of nonsterile syringes in
parenteral manipulations.
--------------------

Zh Mikrobiol Epidemiol Immunobiol. 1990 Mar;(3):23-6.

[HIV transmission from child to mother during breast feeding]

[Article in Russian]

Pokrovskii VV, Eramov IIu, Kuznetsova II, Sliusareva LA, Lipetikov VV.

Out of 6 mothers breast-feeding their parenterally infected children in
Elista and having no other factors of HIV infection, 3 were found to have
antibodies to HIV, as well as 4 women who breast-fed their children dead
in the focus of infection, but not examined. Pronounced stomatitis in
children and cracks on their mothers' nipples were additional factors
leading to HIV infection of mothers.

------------------------------------------------
The adoptive mom who is contemplating breastfeeding would need to 
realize that the risk of HIV transmission might not ultimately be 
just to herself, but to any other nursing child, and to her 
husband/partner. Unless an adopted mom is able to satisfy herself 
that the birth mother was not HIV-infected, and/or that the baby is 
definitely not infected, then it might be an idea to suggest 
provision of expressed breastmilk until tests on the baby can be done 
(at least two negative test results from six weeks after last 
possible exposure, ie birth or last breastfeeding) before embarking 
on breastfeeding direct. This has been the same information that I've 
given to all my adoptive mom clients over the years, wherever they 
live and wherever their new babies will be coming from.  I don't 
think a nipple shield would provide adequate protection, since the 
baby "innoculates" the breast with other infections, and the 
possibility would exist with HIV.  But as far as I know, there has 
been no research on this.

But providing an HIV+ baby with expressed breastmilk would no doubt 
be the greatest thing an adoptive mom could do for the baby. HIV+ 
babies who are untreated (ie those who don't have access to 
antiretroviral drugs) and have breastmilk live twice as long as those 
who are formula-fed, because of all the protective factors against 
opportunistic infections they receive in breastmilk.  Of course, 
treatment with antiretrovirals has turned HIV into a chronic rather 
than a lethal disease, but babies of mothers whose mothers have such 
high viral levels at birth that they become infected themselves may 
not do so well (50% mortality by age 2) and breastmilk would be a 
great gift.

Pamela Morrison IBCLC
Rustington, England
------------------------------------

Date:    Sun, 17 Jul 2011 10:34:23 -0400
From:    Mary Oconnor <[log in to unmask]>
Subject: HIV transmission from BABY to MOM

Does anyone have any references regarding HIV transmission from baby 
to mom through breastfeeding?  I have been asked by a friend who 
works for Project Hopeful in international adoptions of children with 
HIV/AIDs.  Many of the adoptive mothers have asked about the 
possibility of HIV transmission from baby to mom through breastfeeding.

Thank you,
Mary

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