Transmission of HIV-1 in the breast-feeding process.

Current laboratory techniques cannot distinguish the mode of vertical transmission (intrauterine, intrapartum, or postnatal) of human immunodeficiency virus type 1 (HIV-1) from mother to infant. The ability to transmit HIV-1 via breast feeding has been established in 24 case reports, primarily involving mothers who seroconvert after delivery. Whether breast-feeding adds a notable additional risk of HIV-1 infection to the risk from pregnancy is controversial. The importance of the duration and intensity of breast-feeding in modulating the outcome of HIV transmission via breast milk also remains unclear. Factors in breast milk may play important roles in an infant's susceptibility to infection with HIV and in the expression of the virus. Pasteurization and storage enhance the intrinsic, antiviral properties of human milk. Banked human milk is pasteurized to destroy the HIV-1 virus but retains properties that may be helpful to infants of HIV-1-positive mothers in developed countries where breast-feeding is not recommended. For infants in populations where the infant mortality rate is high, the risk of death associated with HIV infection acquired via breast milk is lower than the risk associated with not being breast-fed.

PIP: To date, 24 cases in which breast feeding was the route of HIV infection have been reported in the literature and the prevalence of this form of mother-infant HIV transmission has been estimated at 13-35%. The majority of cases involve mothers who seroconverted after delivery. Overall, the risk appears to be highest in cases of high viremia and low antibody levels, as seen immediately after infection and in end-stage AIDS. This risk can be lowered, however, by zidovudine therapy during pregnancy and at delivery. Evaluation of the risks and benefits of breast feeding when maternal HIV infection is present must be based on factors such as the country's infant mortality rate, infectious disease mortality, HIV prevalence in women of childbearing age, and availability of safe alternative methods of infant feeding. In African countries where the infant mortality rate is high and the rate of HIV transmission via breast milk is about 20%, the HIV-associated infant mortality rate among breast-fed infants is lower than the mortality rate from infectious diseases in non-breast-fed infants. A decision analysis model indicates that, in most cases, the benefits of breast feeding outweigh the risks of HIV transmission in developing but not developed countries. Infants of HIV-infected mothers in developed countries can be fed stored human milk pasteurized to destroy the HIV virus.

Infant feeding decisions among pregnant women from a WIC population in Georgia.

A survey comparing the anticipated choice of feeding method with attitudinal, social influence, and psychological variables was conducted in a WIC population (no. = 120) in the East Central Health District of Georgia. Attitudinal variables had a stronger relationship with the choice of feeding method than either the social influence or psychological variables. When all the variables that were associated with choice of feeding method were analyzed with multiple regression analysis, the positive attitudes toward breast feeding scale had the strongest impact on choice of method, followed in order by method preferred by the father, the positive attitudes toward formula scale, and the knowledge about breast feeding scale. The regression model consisting of those four variables explained 64% of the variation in choice of feeding method and correctly classified the women's feeding method choice in 82% of the cases. These findings suggest that breast-feeding promotion interventions should be provided by health care professionals at critical times during the prepartum period and that fathers should be included in the discussion of the infant feeding decision.

Receptor-mediated dopaminergic function after ethanol withdrawal.

Striatal dopamine (DA) synthesis, measured in vivo as accumulation of DOPA after aromatic amino acid decarboxylase inhibition, is increased by neuroleptics and decreased by DA agonists as a result of their interactions with regulatory receptors. A sensitive high performance liquid chromatography (HPLC) technique has been developed, which allows the evaluation of both increases and decreases in DOPA levels in response to agonists and antagonists, and simultaneously permits measurement of DA levels as an indication of DA neuronal activity. C57BL mice, after chronic ethanol treatment and withdrawal, demonstrate significantly decreased responses, in terms of DOPA accumulation and DA release, to both haloperidol, a DA antagonist, and apomorphine, a DA agonist. These effects cannot be interpreted as resulting either from DA receptor subsensitivity or supersensitivity, but suggest instead that coupling between DA receptors and tyrosine hydroxylase is perturbed by ethanol treatment.