Miami Herald (MH) - Thursday, August 29, 1991
Elinor Burkett; Herald Staff Writer

"This is not surprising to physicians in the United States," said Dr. Mary Jo O'Sullivan, director of the department of obstetrics and gynecology at Jackson Memorial Hospital. "We all suspected there was a risk of transmission of the virus through breast milk, but this provides us with proof."

The degree of risk remains unclear, according to the team of African and European researchers. But the finding raises concern because nearly 80 percent of America's 20,000 female AIDS patients are of childbearing age.

The new report was based on the study of babies born to 16 Rwandan women who had tested negative for HIV before childbirth but tested positive shortly after -- suggesting they had been infected during their pregnancies. None of the infants tested positive just after delivery, but nine turned out positive within 21 months. At least three of them were infected by their mothers' milk, the researchers conclude.

"Our results have important public health implications for breast-feeding in the context of AIDS," the authors wrote. They recommended that when a safe alternative to breast-feeding is available, pregnant women at high risk for HIV should refrain from breast-feeding their babies -- even if they test negative.

O'Sullivan does not believe that advice is appropriate for pregnant patients at Jackson, almost 2 percent of whom are infected with HIV. In Miami, which has the second highest rate of heterosexually transmitted AIDS in the country, such a policy would mean O'Sullivan would have to advise virtually all of her patients to abstain from breast-feeding. "Instead, we routinely offer and suggest they be tested, and 60 to 90 percent accept testing," she said.

Patients who test positive are counseled not to breast-feed.

To date, most of the concern about mother-to-child transmission of HIV has focused on transmission during pregnancy. Between 25 and 30 percent of the infants of infected mothers are born with the virus. While the new study suggests that the risk of transmission through breast-feeding is considerably lower, it raises particular concern because many pregnant women are not tested for the virus prior to giving birth -- or test negative because they have not yet developed antibodies to it -- and may inadvertently infect their children.

In some urban areas in the United States, up to 8 percent of women of childbearing age are infected with HIV.
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