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December 23, 1988

The Transmission of AIDS: The Case of the Infected Cell-Reply

Author Affiliations

University of California San Francisco

University of California San Francisco

JAMA. 1988;260(24):3587. doi:10.1001/jama.1988.03410240044014

In Reply.—  I appreciate the comments by Dr Robbins and Drs Cocchi and Cocchi. Because the major source of HIV transmission in seminal fluid is infected cells, my remark about nonoxynol 9 was made specifically to underline this point. The effect of nonoxynol 9 has been documented only on infectious virus, not on infected cells. In fact, there have been no clinical studies showing that this compound helps prevent HIV transmission. Thus, one cannot assume that nonoxynol 9 is an effective means of protection against the sexual transmission of acquired immunodeficiency syndrome.The presence of HIV in milk has been reported.1,2 It can be found as free virus as well as associated with infected cells. Nevertheless, the level of infectious virus appears to be low. Certainly, new-borns with a less developed gastric mucosa may not have sufficient acid to kill virus or virus-infected cells. Therefore, the greatest risk for