Pamela got me thinking about my comment in regard to the use of PCR for
testing infants under one month.  My notes had the comment that 50% were
false positives and the reason for not using PCR in the first month.    What
my reference says is that the "sensitivity of this assay is sufficient to
detect about half of infections in the first month of life."  My other
reference states that "false positive results due to contamination are the
major pitfall of this test."  I think I must have put the two ideas together
and written it in my notes.  One of the references goes on to say:

"PCR is not recommended as a diagnostic test for postexposure diagnosis of
HIV infection either following needlestick or sexual exposure because of
misleading false positive or false negative results....It must be emphasized
that virological diagnosis still largely depends on clinical and
epidemiological criteria, with laboratory tests including PCR functioning in
a complementary supportive role." from the National Institute of Virology,
University of Witwatersrand, South Africa

http://www.niv.ac.za/lessons/current/les10_1.htm

The PCR test kits use to and still may say that the test should not be used
as a diagnostic.  In a book called Mother to Child Transmission of Hiv and
its Prevention with AZT and Nevirapine:  A Critical Analysis of the Evidence
by Eleopulos et al. there is quote from researchers in the USA who did a
meta-analysis of studies published between 1988-1994 on PCR sensitivity and
specificity.  The researchers from this meta-analysis state,  "The
false-positive and false-negative rates of PCR that we determined are too
high to warrant a broader role for PCR in either routine screening or in the
confirmation of diagnosis of HIV infection."

I find it very difficult in the light of how unreliable this testing is and
the confusion of maternal antibodies in the infant's bloodstream to believe
that we have the evidence to believe that breastfeeding is one of the routes
of hiv transmission.  The case that was brought up on this list as the first
documented case of hiv transmission through breastfeeding must be the case of
Elizabeth and Ariel Glasser.  I believe there is grounds to believe that it
was blood transfusions, not breastfeeding, that caused that hiv transmission.
  Valerie W. McClain, IBCLC

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