I have been following this thread with much interest, looking for others'
opinions.  I was at a meeting attended by concerned nursing staff a couple
of years ago and a similar question came up.  A grandmother was
breastfeeding her daughter's orphaned baby.  The mother had died of AIDS.
The grandmother was also breastfeeding her own baby.  The question was asked
- was the grandmother's own baby placed at risk for HIV infection via the
adopted baby?  No-one could answer, and the question has bothered me ever
since.

There might be several possibilities.  (1) If the mother had died of AIDS,
then the adopted baby would have been placed at a higher risk of acquiring
the virus. (2)  If the adopted baby had a new infection, then the
grandmother would also be more at risk of transmission.  (3) The same
problems in testing the adopted baby would apply to testing any newborn baby
- how reliable is the test when babies who have not been breastfed can test
negative at birth and then positive any time from 2 - 90 days??  (4) If the
adopted baby was, indeed, infected then he would be more likely to suffer
from oral thrush, which could lead to oral lesions as well as sore or
cracked nipples in the adoptive mother (grandmother), thereby increasing the
risk of transmission.  (5) Would each baby be assigned only one breast?  If
so, would this reduce the grandmother's own baby's risk?  (6) If the
grandmother *did* acquire HIV from her daughter's baby, then her own baby
would stand a 29% chance of sero-converting via breastfeeding within the
same three-month period.

Hypothetical, yes.  But when we think of wet-nursing as a feeding option for
the babies of HIV-infected mothers perhaps these possibilities should be
considered. If I work with a potential adoptive mother now, I always ask her
if she is aware of the HIV-status of the birth mother, and suggest that she
should take her doctor's advice on this.

Of course, even this is taking a risk - how can we know that the birth
mother has *not* been so recently infected by her partner that *her* test
will be unreliable too?   I guess the only really safe way to manage this
would be to express the milk for three months, then test the baby and then
take it from there.  I HATE this subject!

Pamela Morrison IBCLC, Zimbabwe