This Myth was very prevalent in the 1990's - thus Dr. Caroline Chantry
designed a project with a group of very generous women who were HIV positive
in Puerto Rico, where Dr. Chantry worked as a Pediatrician in a program that
cared for babies and children whose mothers were HIV+.  These mothers
expressed milk and donated it to the project through the development of
mature milk - all the while knowing their milk would NOT be given to their
babies, as at the time it was not clear  what would work in terms of safety.

Chantry CJ, Morrison P, Panchula J, Rivera C, Hillyer G, Zorilla C, Diaz C.
Effects of Lipolysis or Heat Treatment on HIV-1 Provirus in Breast Milk.
J Acquir Immune Defic Syndr 2000 August; 24 (4): 325-9.
(published October 2000)

The study was published, and can be freely downloaded from:
http://www.qaproject.org/strat/misc/Lipolysis.pdf

The evidence showed that lipolysis was NOT adequate to make the milk safe
for infant consumption:

ABSTRACT
Background: Transmission of HIV-1 infection through breastfeeding is
associated
with integrated DNA (provirus) in milk cells. Reduction of HIV-1 DNA in milk
may lessen infectivity.

Purpose: To investigate efficacy of two methods available in developing
countries to reduce HIV-1 proviral DNA in breastmilk.

Methods: Methods simulated field conditions; milk was heated by bringing to
a
boil, as over a cooking fire, and lipolysis was at room temperature. Four
HIV+
pregnant women were recruited for this pilot study, instructed to
exclusively
formula feed and stimulate milk production via pumping. Milk was collected
twice
weekly for three weeks and analyzed qualitatively for HIV-1 proviral DNA by
polymerase chain reaction at three stages: 1) fresh, 2) after standing for
six
hours, and 3) after bringing to the boiling point.

Results: Seventeen samples from four mothers were analyzed. Fifteen of
seventeen
fresh samples (88%) had measurable HIV-1 proviral DNA despite all mothers
having
low or undetectable plasma viral loads. Lipolysis (standing at room
temperature) for six hours did not destroy proviral DNA: 6/7 samples (83%)
were
positive for DNA after lipolysis. No samples of milk (0%, n=8) brought to a
boil
were positive for HIV-1 proviral DNA (p<.0001).

Conclusions: This preliminary evidence suggests: a) inherent lipolytic
activity of fresh breastmilk is inadequate for destruction of HIV-1; b)
bringing breastmilk to a boil may result in decreased HIV-1 infectivity; and
c) breastmilk cell-associated HIV-1 may not reflect plasma viral load.
Nutritional value or possible bacterial contamination of milk treated in
this manner was not assessed.

Since then, there have been many more studies that have found that
heat-treatment IS effective.  We want HIV positive mothers to be able to
provide optimal infant nutrition - at the same time we need to keep in mind
risk-benefit ratios based on where they live and what options AND dangers
exist in their environment.

Jeanette Panchula, BSW, RN, PHN, IBCLC
California, USA

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