Hi Darillyn

Do you keep your old emails?  I see that there was some 
correspondence involving you, me and Dr Alla Gordina on this very 
topic in February 2013.  You mentioned kissing in that query 
too.  But for now, you're absolutely correct, and sorry to hear that 
the mom was a bit miffed... she may be denying the risk, but there is 
one and you were right to warn her of it.  While EBM would be of huge 
value to the baby, the risk of child-to-mother transmission of the 
virus, and the consequent risk to the mother's sexual partner and 
possibly other children, would be of concern.  There was a recent 
study, see http://www.ncbi.nlm.nih.gov/pubmed/22668802

Regarding HIV testing for the baby, WHO recommends provision of 
antiretroviral prophylaxis for all HIV exposed infants for 6 weeks, 
to mop up any virus acquired at birth.  The baby should have been 
tested at birth and again at 6 weeks by polymeriase chain reaction 
(PCR) testing.  Two negative tests by 6 weeks of age should establish 
that the baby is not infected.  It would be important to use an assay 
which would detect the HIV sub-type in the mother's own country.  A 
PCR will give an earlier diagnosis of HIV-infection because the 
window period is shorter.   Early versions of the PCR did not always 
test for all HIV sub-types, and not all PCR tests have the same 
sensitivity. The choice of assay should be dictated by the prevailing 
HIV sub-types in the country.  Furthermore, early testing is 
important so that infected infants, regardless of clinical or immune 
status, can immediately start medication to improve their chances of 
survival. A second confirmatory HIV test should be done, but this 
should not delay starting treatment.   You can find out more from the 
WABA documents at http://hivbreastfeeding.org

I hope this helps.

Pamela Morrison IBCLC
Rustington, England
---------------------------------------------------------
Date:    Thu, 2 Apr 2015 12:16:36 -0600
From:    Darillyn Starr <[log in to unmask]>
Subject: Risk of HIV transmission baby to mom through BF

Recently, someone on our adoptive breastfeeding group has asked about 
breastfeeding a baby whose birth mom was HIV+.  I basically just said 
that there have been cases where that has happened and that my 
preference would be for the baby to be fed in a way as close to 
breastfeeding as possible, so that, when a dependable negative screen 
was obtained, switching would be easier.  I also said that if she 
could pump milk to feed the baby during that time, it would be very 
beneficial.  She got a bit miffed with me and someone else said that 
if HIV can't be transmitted by kissing, it can't be by breastfeeding, either.

What would you ladies (and gentleman) say to someone who wanted to 
breastfeed an adopted baby who was born of a woman who was known to 
be HIV+?  Also, does anyone know how soon a dependable negative test 
can be done on a baby?
  			   		  


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