>> The transmission rate was 3-4 times higher among the breastfed
>>babies than the formula fed.  Isn't the point that bf advocates have to be
>>aware of these statistics  and to realize that we are talking about
>>prevention of a deadly disease?

I haven't seen the article yet, but from the discussion so far, I want to
know if the following issue is addressed, or if it is perhaps a moot
point:  From the research that I read a couple of years ago, one
signficant factor in predicting transmission rate was the HIV status of
the mother. Apparently transmission rates are highest during
sero-conversion, when the level of the virus is very high in the mother's
system. Once seroconversion is completed, the virus is supposedly in
lower levels and less likely to infect via breastmilk, especially with
human milk's propensity to bind with HIV and prevent reproduction (I'm
loosely paraphrasing one study).

So then we have to examine each individual scenario.  If a mother was HIV
positive before pregnancy, she has passed the seroconversion stage
already. In the meantime, her baby has already been exposed to the virus
and is already at risk of transmission.  It is difficult to tell a baby's
status at birth because the baby can have a false positive rate, which
takes a few to several months to resolve to the real status.  The
question that needs to be asked, then, is what is the transmission rate
for previously infected mothers vs the risk of transfer via breastmilk
after birth vs baby getting no breastmilk at all to help fight off the
potential virus?

Next scenario: mother becomes infected during the pregnancy.
Seroconversion can occur quickly or slowly-- if the mother converts
around the time of delivery, baby may or may not have already been
exposed, but defintely would have high exposure immediately postpartum
via breastmilk. I see this as a high risk situation for the baby, as
transmission may not have occurred in utero. (I don't know the
transmission rate in utero pre-seroconvert).

Third scenario: mother is exposed to HIV after birth.  This presupposes
that baby has not ever been exposed and is healthy at birth. If the
mother sero-converts during breastfeeding, the transmission risk is
definitely higher, and ABM, IMO, is the best choice.

Looking forward to reading the article and the ensuing discussion on
lactnet.

-Lisa Marasco, BA, IBCLC