The best article I have ever read on HIV and breastfeeding is:
Infant feeding policy and practice in the presence of HIV-1 infection
Nicoll A, Newell ML, Van Praag E, Van de Perre P and Peckham C
published in AIDS 1995, 9:107-119
Copyright Current Science Ltd ISSN 0269-9370
Requests for reprints to: Dr A. Nicholl, Communicable Disease
Surveillance Centre, 61 Cloindale Avenue, London NW9 SEQ

The article is a broad overview of current knowledge (1995),
including taking into account the risks of artificial feeding (these
are well stated), and extensively reviews the literature on HIV and
breastfeeding.  It would appear from available data that there is a
sinificant attributable risk of vertical transmidssion through
breastfeeding by HIV+ mothers, but the authors suggest that
explicative research might aim to determine *when* breastfeeding
transmission of HIV-1 takes place and the factors associated with
higher risk of transmission. Recently infected mothers (eg through
blood) with acute viraemia certainly seem to be more at risk of
transmission through milk.

The issue of *when* breastfeeding transmission occurs with a mother
who is already known to be HIV+  is interesting, because two studies
have suggested that most transmission may be confined to shortly
after birth (colostrum with its higher cellular content), rather than
spead evenly throughout the breastfeeding period, although this has
yet to be proven.  It has interesting implications though.

Lets hope all this becomes more academic as science progresses in the
whole management of HIV.  There are exciting reports coming out of the
Vancouver conference.

Ros Escott
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