1. ILCA Print and Multimedia Reviews
March 2013 – Available at www.ILCA.org
Human Immunodeficiency Virus type 1 (HIV-1) and Breastfeeding: Science, Research
Advances, and Policy
Athena P. Kourtis and Marc Bulterys, Editors
Advances in Experimental Medicine and Biology, Vol 743, 2012
315 pages, illustrated, references, index, US$209, hardcover; $169.99, e-book
Orders: Springer Science + Business Media, 233 Spring Street, New York, NY 10013 USA
URL: www.springer.com/medicine/book/978-1-4614-2250-1#
Two contiguous and explosive sentences in the second paragraph of the first foreword unveil little-
publicized knowledge about mother-to-child transmission (MTCT) of HIV: “It continues to be a
mystery why the majority (60-85%) of infants born to HIV-infected women are not infected with
HIV without receipt of any intervention. It is also mystifying that a majority (85-90%) of all HIV-
exposed babies, who consume hundreds of liters of HIV-infected breast milk with frequent daily
feedings, escape infection” (p. vii). Instead of using these blinding observations to investigate the
mechanisms (or lack thereof) of HIV-1 transmission through human milk, most of the research
presented in this volume revolves around the use of anti-retrovirals and changes in infant feeding
practices to meet the goal of “the virtual elimination of new cases” (p. 3).
Research on epidemiology of HIV-1 transmission through breastmilk, its virology, immunology, and
prevention and treatment (in animal models and in human) is covered, sometimes in excruciating
details. A good, yet brief, history of policy making explains when and why policy makers took away
the right of infant feeding decision from mothers. Chapter 3, in particular, is heart wrenching. The
MTCT discourse places an inordinate and unfair social pressure on women, who fear that the way
they feed their babies will betray their HIV status if their practice is different from the local one
(because of health officials’ recommendations). In the case of breastfeeding, some women feel like
criminals because they knowingly transmit a harmful virus through their milk to their babies. Yet, in
societies where women have rights to neither self-determination nor decision power in the way their
babies will be fed, there is a total information blackout on how these women became infected or on
the HIV status of the babies’ fathers.
Two aspects are barely covered in this treatise. One is the nutritional status of HIV-1 carriers.
Research shows that HIV carriers experience profound deficiencies in multiple health-promoting
micronutrients and are therefore malnourished. The other is co-infection. One short section addresses
specifically infections of opportunistic and harmful pathogens that are commonly associated with
HIV-1 transmission. Therefore, using HIV-1 carriers’ nutritional and health status as the research
control conditions provides an unexplored and powerful angle to probe the mechanisms of HIV-1
transmission through human milk. Hopefully, the next volume will shed light on these two issues.
Nicole J Bernshaw, MSc, IBCLC
Salt Lake City, Utah USA
© International Lactation Consultant Association