Karen,

When I wrote:
<<HIV is not transmitted casually and breastfeeding was the only possible
route of transmission from Elizabeth to Ariel...>>  I should have defined
what is meant by casual contact.

I probably should also have written that HIV is transmitted through semen,
blood, vaginal secretions and breastmilk. It is not transmitted in even very
close personal interaction between an HIV positive person and one who is HIV
negative (or 2 who are both positive for that matter). After birth, an HIV
positive mom who is not breastfeeding, no matter how close the mother-baby
bond, is not going to have the kind of contact necessary for the transmission
of HIV unless, G-d forbid, she is abusing her baby. HIV is transmitted
through sexual contact particularly vaginal or anal intercourse without the
use of latex condom, sharing needles among IV drug users, accidental exposure
of health care workers to the blood of an HIV positive person (eg, needle
sticks), infected blood products, mother-to-child during pregnancy and birth,
and through direct breastfeeding by an HIV positive mom. The evidence is
quite clear that here is no transmission of HIV among family members unless
it is by on of these routes.

About your point of babies testing negative initially and then testing
positive, I found this just released document "Guidelines for the Use of
Antiretroviral Agents in Pediatric HIV Infections" issued on 1 March 1999 by
the Working Group on Antiretroviral Therapy and Medical Management of HIV
Infected Children convened by the National Pediatric and Family HIV Center,
the Health Resources and Services Administration and the National Institutes
of Health.

In the discussion of testing infants for HIV infection, it states that HIV
infection can be definitively diagnosed in most infected infants by 1 month
and virtually all by 6 months. If the test is positive, it sould be repeated
as soon as possible. The tests used are HIV culture, and DNA or RNA
polymerase chain reaction (PCR). DNA PCR is the preferred test at this time.
38% of infected babies will test positive at 48h and 93% at 14 days. RNA PCR
may be valuable for diagnosis of perinatal HIV infection and may even prove
to be more sensitive than a DNA assay, but the data are limited on the
specificity and sensitivity of the RNA assay compared to the DNA PCR test.

The test should be performed before 48h, at 1-2 months and at 3-6 months. If
the initial test is negative, the baby should be re-tested at 1-2 months.
Most babies of HIV positive moms will receive 6 weeks of antiretroviral
chemoprophylaxisis. ZDV therapy does not affect the sensitivity and
specificity of HIV tests. However, the impact upon tests results of more
intensive combination antiretrovirals currently used in pregnancy is unknown.


HIV exposed babies who test negative at birth and at 1-2 months should be
retested at 3-6 months. HIV infection is diagnosed after 2 positive tests on
two separate blood samples. HIV infection can be ruled out if there are 2 or
more negative virologic tests, two of which should be performed at 1 month of
age or later and one of those performed at 4 months or later. HIV IgG
antibody tests can be used when the baby is at least 6 months old if the baby
has no signs of HIV infection. At least 2 tests should be done with one month
intervals between the tests. HIV infection can be definitively ruled out at
18 months if the child has no clinical symptoms, HIV IgG antibody is negative
in the absence of hypogammaglobinemia and the virologic assays are negative.

Karen, I know that this may not sway your thinking on HIV infection. It does
point out that HIV diagnosis may be difficult in infants even with the newer
tests that are available now. HIV cannot be ruled out in exposed babies until
they are 18 months old.

The article I cited may be found at  <A HREF="http://hivinsite.ucsf.edu/">HIV
| InSite | Home
</A> as a PDF file. Click on Updated Pediatric Guidelines on the homepage to
download the file. The website also has a great section on Women and HIV
under Key Topics. It includes a good section on perinatal HIV issues and
breastfeeding including abstracts of many of the articles cited on Lactnet in
the discussion of HIV/AIDS.

Warmly,
Carol Kelley  LLLL
Taylors SC USA
mailto:[log in to unmask]

Reference:
Working Group on Antiretroviral Therapy and Medical Management of HIV
Infected Children. Guidelines for the use of antiretroviral agents in
pediatric HIV infection. HRSA and NIH   March 1999

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