MORE HIV, LESS INFECTION: THE BREASTFEEDING CONUNDRUM
Posted by Henry Bauer on 2007/11/21
Women who are HIV-positive may deliver HIV-positive babies, though in the majority of cases they do not. However, some HIV-negative newborns subsequently, within weeks or months, also become HIV-positive. In most of these cases, the only risk factor is the mother’s milk. So–“obviously”–HIV must have been transferred from mother to child via breastfeeding.
It follows that the more mother’s milk a baby ingests, the greater the likelihood that the baby will become infected.
Wrong! Some studies have reported, for example, that “Infants exclusively breastfed for 3 months or more had no excess risk of HIV infection over . . . those never breastfed” (Coutsoudis et al., AIDS, 15 (2001) 379-87); while other studies have even reported a lower rate of HIV infection among exclusively breastfed babies, for example, “Breastfed infants who also received solids were significantly more likely to acquire infection than were exclusively breastfed children” (Coovadia et al., Lancet, 369 (2007) 1107-16).
That’s puzzling enough, but matters become yet more puzzling when the babies’ health rather than HIV-status is considered: “Risk factors for death included not being breastfed (OR [odds ratio] 8.5, p=0.04 [p < 0.05 is usually taken as demonstrating statistical significance]) . . . . HIV status (maternal or infant) . . . [was] not associated with the risk of death” (HATIP [HIV & AIDS Treatment in Practice] #74, 12 September 2006).
So a deadly virus is less efficiently transmitted via mothers’ milk, the more a baby is fed nothing but mothers’ milk; and babies fed that deadly virus in their mothers’ milk are 8 or 9 times less likely to die in infancy than are babies not exposed to that deadly-virus-purveying fluid.
Once again, as with the fact that married women are at the greatest risk of contracting HIV (post of 18 November), if you believe that, then you will also be sending money to Nigeria to someone you had never heard of before and who offers by e-mail to share with you a large unclaimed inheritance. Or perhaps you already are part owner of a Brooklyn Bridge.
However, doctors and researchers and activists who follow HIV=AIDS dogma not only have to believe this nonsense, they are obliged to attempt to act on it. Little wonder that they are confused and that official advice to HIV-positive mothers covers the gamut of “never breastfeed” to “exclusively breastfeed”. In Botswana, “formula feeding among HIV-positive women is virtually universal . . . (~98% of infants in the HIV-transmission study were formula fed)” yet “mortality data shows that something isn’t working . . . . among HIV-positive women, Botswana should do more to support truly exclusive breastfeeding” (HATIP #74, as above). On the other hand, officials in Barbados consider breast-feeding “something no HIV positive mother should do” (“Breast-milk, HIV/AIDS linked”, 5/13/07, Barbados). At International AIDS Conference XVI in Toronto, 2006, “there were over one hundred presentations on infant feeding (mostly posters) – but if there was any unifying theme in the hodgepodge of studies, it was the recognition that safer infant feeding is a growing dilemma in desperate need of a solution. Misconceptions about safer infant feeding practices were common in many of the poster presentations, while frustration surrounding how best to counsel HIV-positive mothers was nearly universal” (HATIP #74, as above).
So the lack of correlation between breastfeeding and HIV “transmission” has occasioned much commenting to and fro. Some defenders of HIV/AIDS theory have tried to nitpick various details of protocol or practice in the reported studies, yet the findings have been confirmed by so many different investigators that the main conclusion seems unassailable. (See http://aras.ab.ca/transmission-BF.html for a collection of quotes about HIV and breastfeeding.) Consequently, most discussion has concerned itself, quite appropriately, with what might be best for mothers and babies in various geographic settings with their varying conditions of hygiene and availability of suitable milk formula. If there is any consensus, it may be this: “The nutrition and antibodies that breast milk provide are so crucial to young children that they outweigh the small risk of transmitting HIV, which researchers calculate at about 1 percent per month of breast-feeding” (“Anti-breast-feeding measure backfires in Botswana, causing more despair”, Craig Timberg, Washington Post. 22 July 2007).
But while it is laudable to make the immediate health of babies the prime focus of concern, that does not entail or permit or excuse any ignoring, sidestepping, evading of the fact that this phenomenon, that more exposure to “HIV” results in less infection, is strong evidence as to what “HIV-positive” signifies.
Earlier posts have pointed out that a positive HIV-test is no proof that virus is present, since virus has never been isolated directly from an HIV-positive person or an AIDS patient. The belief that HIV is transmitted from mother to child rests exclusively on observations that children of HIV-positive mothers are or become HIV-positive themselves, sometimes but far from always (probability about 1% per month, see above). Since this belief makes it necessary to believe also the almost unbelievable, namely, that more virus-containing milk leads to less transmitting, it would seem reasonable to look for an alternative way of coping with these puzzling facts. I say “almost” unbelievable because the suggestion has been made that something in milk formula makes babies more prone to infection when exposed to HIV. Believe that if you will.
A much more satisfactory alternative explanation is at hand. As discussed in earlier posts, “HIV-positive” reflects some sort of health challenge, not necessarily serious or permanent, rather akin to a fever, quite non-specific as to what the cause might be. Under this view, HIV-positive mothers reacted more vigorously to some unspecified health challenge–possibly pregnancy itself–than did HIV-negative mothers. Thus HIV-positive mothers are somewhat less likely to be in the best of health, and therefore somewhat more likely to deliver less-than-healthy babies–who are for that reason likely to test HIV-positive more often than newborns of HIV-negative mothers. That explanation permits breastfeeding to remain the unqualified good thing that it has long been known to be, because of the protection that components of that milk afford. That protection explains why exclusively breastfed children, whether of HIV-positive or HIV-negative mothers, are likely to be healthier–and less frequently HIV-positive–than children who are only partially breastfed or not breastfed at all. Among those not exclusively breastfed, “increased morbidity and mortality . . . was particularly pronounced when the infant was HIV-infected” (HATIP #74, as above)–in other words, HIV-positive infants, being health-challenged in some way, are particularly prone to sickness and death in absence of the benefits conferred by breastfeeding.
The copious literature on breastfeeding in relation to HIV adds further support to the view that “HIV-positive” correlates with a higher likelihood of ill health, but is not the cause of such a prognosis; nor does it demonstrate the presence of a virus that is responsible for the poor prognosis.
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