San Francisco Chronicle; Thursday, August 29, 1991

Although unable to quantify the risk of spreading the AIDS virus through mother's milk, AIDS experts found the link so evident that they recommended that infected women or potentially infected women avoid breast-feeding if safe, bottled formula is available.

The finding has wide implications because 78 percent of the nearly 20,000 AIDS cases among women reported to the national Centers for Disease Control involve women of childbearing age.

But it is particularly troublesome for mothers in underdeveloped countries, where the safe water needed for infant formula is often in short supply.

Acquired immune deficiency syndrome destroys the body's immune system, leaving patients helpless in fighting a host of diseases ranging from pneumonia to extremely rare cancers.

The disease is most commonly spread through intimate sexual contact, the sharing of needles by intravenous drug users, contaminated blood and, although it is not clear how, at birth from an infected mother.

BREAST MILK SUSPECTED

Doctors have also long suspected that the AIDS virus can be passed to infants through breast milk, but until now the evidence had consisted of isolated cases.

The new study, published in today's New England Journal of Medicine, involved a systematic examination of 212 healthy women whose blood was tested for AIDS when they gave birth and at three- month intervals thereafter.

Sixteen of the women showed signs of the AIDS virus HIV-1 in their blood after giving birth. Nine of their 16 babies developed the infection, and traces of the virus always appeared in the babies at the same three-month interval in which the mother became infected.

Because all infected infants were breast-fed, researchers concluded that the colostrum initially secreted by the breast and "breast milk may be efficient routes for the transmission of HIV-1 from recently infected mothers to their infants."

Colostrum is a thin, yellow fluid released by the breast during pregnancy before milk production begins. It contains white blood cells, water, protein, fat and carbohydrates.

"When a safe alternative to breast-feeding is available, women at risk . . . should refrain from breast-feeding their babies," said the group, led by Dr. Philippe Van de Perre of the National AIDS Control Program in the African nation of Rwanda.

THIRD WORLD PROBLEM

But because the alternatives are not always safe in Third World countries where water used to make bottle formula may not be pure, further studies may show that it is better to have another woman breast-feed the child if the baby is at risk of getting the AIDS virus from a mother at high risk for the disease.

That recommendation was echoed by Dr. Philip Pizzo and Karina Butler of the National Cancer Institute, who said in an accompanying editorial that breast feeding should still be encouraged "in countries where the lack of safe water supplies precludes the use of bottle formulas."

The precise level of risk that a child will contract the AIDS virus from breast milk was not determined in the study.

Five of the 16 infants -- along with their mothers -- were found to be infected when three months of age, suggesting that the infection occurred in the womb and appeared after birth.

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