Phyllis

Hope this is not too late for you - have only just caught up on a few
digests....

Yes, I've certainly heard of the possibility of allowing breastmilk
to stand at room temperature for a certain length of time in order to
inactivate HIV.  The possibilities are quite fascinating.

In 1990 it was first noted that milk lipids were antiviral against
HIV in spiked milk samples that sat on the counter as controls while
other samples were being heat-treated.  It was thought that the
antiviral activity was lipoprotein-lipase dependent and occurred only
in stored milk in which the lipase had had a chance to break lipids
down into free fatty acids.  The effect was cumulative (the more that
are present, the more effective the antiviral activity) and viral
killing was rapid when the free fatty acids come into contact with
the envelope of the virus.  In cases such as HIV infection, in which
the virus may be found in the acellular fraction of the milk as well
as the cellular fraction, it was stated that the antiviral lipids
might reduce the risk of viral transmission by destroying the free
virus. In 1993 researchers looking at pasteurization for the HMBNA
also noted that input HIV-1 titer could not be recovered from control
human milk preparations that were innoculated with HIV, but not
heated.  They thought that this was due to inactivation of HIV-1
infectivity by the milk, rather than to cellular toxicity or
interference with detection of viral replication.   Other researchers
found that milk concentrations as low as 10% had some anti-viral
activity. Titer reduction occurred rapidly, within 5 - 10 minutes and
was more efficient at 37 degrees C and 22 degrees C than when HIV-1
was mixed with milk at O degrees C. Although the study was done to
assess the effectiveness of  Holder pasteurization in destroying the
HIV virus in  human milk, the researchers stated that the magninitude
of inactivation could not be attributable to heat alone although the
required concentration for maximum viral inactivation varies.

Interestingly, studies to determine the number of HIV-1 infected
cells in breastmilk, the quantity of HIV-1 in cell-free breastmilk,
in order to determine its infectivity are always done on breastmilk
samples that have had the lipid layer removed and discarded.

However, another study in 2000 dashed all our hopes!   I'm pasting
the ref and abstract below:

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 Aug 1;24(4):325-9.

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 breast milk. METHODS: Methods simulated field
conditions; milk was heated by bringing it to a boil, for instance,
over a cooking fire, and lipolysis was done at room temperature. Four
HIV-positive pregnant women were recruited for this pilot study,
instructed to feed formula exclusively, and to stimulate milk
production using pumping. Milk was collected twice weekly for 3 weeks
and analyzed qualitatively for HIV-1 proviral DNA by polymerase chain
reaction at three stages: 1) fresh, 2) after standing for 6 hours,
and 3) after having been brought to the boiling point. RESULTS:
Seventeen samples from 4 mothers were analyzed. Fifteen of 17 fresh
samples (88%) had measurable HIV-1 proviral DNA despite all mothers'
having had low or undetectable plasma viral loads. Lipolysis
(standing at room temperature) for 6 hours did not destroy proviral
DNA: 6 of 7 samples (86%) tested positive for DNA after lipolysis. No
samples of milk (n = 8) brought to a boil were positive for HIV-1
proviral DNA (p <.0001). CONCLUSIONS: This preliminary evidence
suggests that inherent lipolytic activity of fresh breast milk is
inadequate for destruction of HIV-1; bringing breast milk to a boil
may result in decreased HIV-1 infectivity; and breast milk
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.
--------------------------------------------------------

[Me again]  Although standing the milk at room temperature has been
shown NOT to be safe, Pretoria pasteurization has been used in
hospitals in South Africa.  And flash-heating (a similar, but
slightly more efficient method of home-pasteurization) has been shown
to inactivate the virus.  Ref and abstract pasted below:

Israel-Ballard K, Donovan R, Chantry C, Coutsoudis A, Sheppard H,
Sibeko L and Abrams B. Flash heat inactivation of HIV-1 in human
milk. A potential method to reduce postnatal transmission in
developing countries. J Acquir Immun Defic Syndr 45 (3): 318-323,
2007 (May 2007)

Background: Up to 40% of all mother-to-child transmission of HIV
occurs by means of breast-feeding; yet, in developing countries,
infant formula may not be a safe option. The World Health
Organization recommends heat-treated breast milk as an infant-feeding
alternative.We investigated the ability of a simple method,
flash-heat, to inactivate HIV in breast milk from HIV-positive mothers.
Methods: Ninety-eight breast milk samples, collected from 84
HIVpositive mothers in a periurban settlement in South Africa, were
aliquoted to unheated control and flash-heating. Reverse
transcriptase (RT) assays (lower detection limit of 400 HIV
copies/mL) were performed to differentiate active versus inactivated
cell-free HIV in
unheated and flash-heated samples.
Results: We found detectable HIV in breast milk samples from 31% (26
of 84) of mothers. After adjusting for covariates, multivariate
logistic regression showed a statistically significant negative
association between detectable virus in breast milk and maternal CD4+
T lymphocyte count (P = 0.045) and volume of breast milk expressed (P
= 0.01) and a positive association with use of multivitamins (P =
0.03). All flash-heated samples showed undetectable levels of
cellfree HIV-1 as detected by the RT assay (P , 0.00001).
Conclusions: Flash-heat can inactivate HIV in naturally infected
breast milk from HIV-positive women. Field studies are urgently
needed to determine the feasibility of in-home flash-heating breast
milk to improve infant health while reducing postnatal transmission
of HIV in developing countries.

I hope this helps.

Pamela Morrison IBCLC
Rustington, England
-----------------------------------------------

Both parents have HIV. 8+ lb term girl born today by c/s. Parents
have been given standard info about NOT breastfeeding here in the US.

Reports are, father KNOWS that if mom pumps and leaves the milk to
stand for 4 hours, then it's safe to feed to the baby. He really
wants his baby to get mom's milk.

Question: had anyone heard this 4-hour myth before? know of an origin?
I'll meet the family for the first time tomorrow.

Phyllis

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