Valerie and Gonneke, the thing that disturbs me about the studies
apparently finding an increased rate of HIV transmission through
breastfeeding during sub-clinical mastitis, mastitis and sore nipples is
that these factors could indeed increase the risk.  But there could just as
easily be *other* reasons.

Without looking this up, I think Semba was the researcher who did the study
in Malawi to show that increased rates of HIV-transmission were associated
with sub-clinical mastitis.  And sub-clinical mastitis was measured by the
elevated sodium in the milk.  Now, those of us who work with breastfeeding
women know that inadequate drainage of the breasts, that might occur with
infrequent breastfeeding, or *mixed feeding* leads to elevated sodium
levels and is a risk factor for mastitis.  The studies by Anna Coutsoudis
showed that there is increased transmission with mixed feeding compared to
exclusive breastfeeding.  So is the sub-clinical mastitis a *cause* of
increased rates of transmission of HIV, or a *consequence* of mixed feeding
(which also leads to increased transmission).  Since breastfeeding
definitions were not very crisp in the Semba study, this at least raises
the question.

With regard to sore nipples.  One of the first symptoms of HIV infection in
babies is oral thrush.  Once again, those of us who work with breastfeeding
mothers and babies know that thrush *causes* sore nipples.  So are sore
nipples in the mother a *cause* of increased rates of HIV infection in the
baby - or are they a *consequence* of breastfeeding an already-infected baby?

Pamela Morrison IBCLC, Zimbabwe (wishing breastfeeding could be deemed
innocent until proven guilty)
[log in to unmask]

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html