The tainted milk of human kindness

Cytomegalovirus was isolated from a respiratory sample by shell vial culture, and a paired blood sample showed a cytomegalovirus viral load of 12?600 copies per mL. HIV transmission via breastfeeding has been well described, with the probability of transmission per litre of ingested breastmilk reported to be similar to that of a heterosexual contact.3 The scarce information available suggests that 1% of infants in South Africa are breastfed by a surrogate.4 However, results from a study in the Free State Province, South Africa, showed that shared breastfeeding by a nonbiological caregiver was the most important factor associated with HIV infection in discordant mother-child pairs.5 Our case highlights the importance of continued education about the risk of HIV transmission via surrogate breastfeeding and the implementation of safe and appropriate infant feeding practices, including HIV testing of all breastfeeding surrogates, especially in view of the decision to halt the provision of formula feeds at public health facilities in South Africa.