Breastfeeding and transmission of HIV [letter]

4 cases of HIV transmitted by breastfeeding ascertained by Mama Yemo Hospital Kinshasa Zaire are reported. 3 infants were breast-fed by mothers who were HIV seronegative during pregnancy who had received HIV-positive blood transfusions and 1 infant was breast-fed by a seropositive wet nurse. Although HIV-1 antibody screening of all blood donors has been in effect since 1986 at this hospital in some emergencies blood cannot be tested in time for the 3-hour ELISA (Organon) results. The 3 mothers had received HIV positive blood during cesarean section and 1 also received 5 units during neurosurgery 11 months postpartum. None of the children were positive when tested at 6 or 9 months of age. The 3rd child was negative until 4 months after her mother seroconverted after her 2nd surgery. None of the children had transfusions injections or scarification nor did the mothers have any mastitis or nipple bleeding. The 4th case a child of a seronegative father and a mother who died but had no clinical signs of HIV had been breast fed by her aunt who developed HIV infection and died when the baby was 17 months old. The child had fever diarrhea cough failure to thrive lymphadenopathy at 11 months of age and oral thrush at 15 months. Data from such cases need to be pooled. Meanwhile antibody testing of wet nurses and breast milk donors would be indicated or banked human milk should be pasteurized.