>>One was a woman who had transfusions after a postpartum hemorrhage, got
the virus from
the transfusions, then passed it on to her baby through breastfeeding. The
other was a baby who had been breastfed by a friend of the mother who was
HIV+ and transmitted the virus to the baby.  The mother was HIV-.  Am I
wrong to believe that these things really do happen? <<

One comment from a non-expert who researched this again last year: The
highest risk of transmission in any mode is during the sero-conversion
stage. So when you say that a mom got infected postpartum and eventually
passed it to her baby, I'm not surprised because she would have been at peak
for shedding the virus during that time. The transmission rate past the
sero-conversion stage is quite a bit lower, however, for whatever it's
worth.

Also: most of the evidence regarding transmission of HIV from mom to baby
points to the birth process. A non-affected baby can pick up the virus
during birth, be negative for a while and then eventually convert; remember,
conversion is not immediate, it takes time. If a mom breastfeeds, the
breastfeeding could be blamed when it actually may have occurred during the
delivery, as another lactnetter pointed out. So yes, the current studies are
not entirely clean.

Concerning detection of HIV-1 in milk: one study found that DNA can be
detected in over 50% of breastmilk samples and was "correlated with CD4
depletion and vitamin A deficiency."

Good reading:

Nommsesn-Rivers L, Heinig, J. (1997) HIV Transmission via Breastfeeding:
Reflections on the issues. JHL 13(3):179-81.

Jacquez, J. (1997) Mother-to-child transmission of HIV-1. J Acquir Immune
Defic Syndr Hum Retrovirol, Dec 1; 16(4):284-292.

Kreiss J. (1997) Breastfeeding and vertical transmission of HIV-1. Acta
Paediatr Suppl Jun; 421:113-117.

No doubt there has been a lot more interesting stuff published in the past
year.

Lisa Marasco, BA, IBCLC

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