Dear Sharon - thank you so much for alerting us to the study you found
showing such poor outcomes on HIV transmission rates with exclusive
breastfeeding.  I would love to know the authors, and the journal citation
and a lot more about it.  I'm having a hard time with the numbers, it looks
like there were only 14 exclusively breastfed babies, and 39% of them became
HIV-infected during the study period - that's 5.46 babies! And of those, 75%
of them became infected by 3 months of age - that's 4.095 babies, and so on
...  Actually I think it's accepted that 70% of babies who test positive do
so by three months of age and that 70% of transmission occurs *at delivery*
so the figure of 75% is not a surprise. A pity that it is still not possible
to identify the route of transmission in those babies aged 90 days and
younger - to know exactly when infection occurs - during pregnancy, during
birth or during early breastfeeding. Interesting that the mixed-fed infected
babies who progressed to AIDS did so in 5.0 months and the exclusively
breastfed ones did so in 7.5 months, (taking 50% more time to do so), yet
the conclusion states that "Exclusive breastfeeding by HIV-infected women
does not .... significantly delay progression to AIDS".

Itching to see the methodology .... !

The study that you are looking for showing a *protective* effect against HIV
transmission with exclusive breastfeeding is Coutsoudis A, Pillay K, Spooner
E, Kuhn L, Coovadia M.  Influence of infant-feeding patterns  on early
mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective
study. Lancet 1999;354:471-76.  The number of mother baby pairs included in
this sstudy was much larger than the study you found, as follows:

At 3 months 18.8% of 156 never-breastfed children were estimated to be
HIV-1-infected, compared with 21.3% of 393 breastfed children.  But wait!
The estimated proportion of infants infected by 3 months was significantly
lower for those *exclusively* breastfed to 3 months (14.6% of 103 infants)
than in those who received mixed feeding before 3 months (24.1% of 288
infants) (2 infants were missing info on exclusive breastfeeding).

Pamela Morrison IBCLC, Zimbabwe
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