Just got back from the annual AAFP meeting, where I attended a talk on
HIV in women.  I asked the lecturer (an internist from Vermont, very
breastfeeding-friendly) all of the recent Lactnet questions; here are her
replies:

Re:  husband who had an affair.  Chances are pretty miniscule that
waiting the week for the test results to come back would allow
transmission.  However, she felt the safest thing to do would be to pump
and dump for that week if mom could handle it amid the stress.

Re:  breastmilk transmission.  The studies of vertical transmission have
indicated about a 20% increase in transmission rates among babies
breastfed by an HIV positive mother.  (Transmission without breastfeeding
has been about 25%, so breastfed babies have about a 30% infection
rate.)  The rate has decreased to as low as 8% with AZT treatment during
pregnancy and labor.  Transmission risk through breastmilk is probably
higher in cases (like the famous Glaser case) where the mother gets a
primary infection while breastfeeding.

She concurred with the CDC recommendation that HIV positive mothers in
the US should generally not breastfeed, but that mothers in developing
countries where the risk of death from other infections in infancy is
high should be breastfed.

Re:  heat treating.  She felt that both a heat and a detergent step would
be necessary to completely inactivate the virus.  This would destroy all
the immune cells and antibodies in the milk, as well as affect the
nutritional quality.  She thought this would not be a good idea.  She
felt donor milk might be a reasonable alternative, keeping in mind all
the other concerns about donor milk, but did not have any data on its use.

I'll post some additional references after I have time to review them.
 --
Anne Montgomery, M.D.
[log in to unmask]
St.Peter Hospital Family Practice Residency
Olympia, WA