Hi Jeanette
I am also interested in this issue.  You may remember a while back there were a couple of posts about a woman in Melbourne who is expecting her baby soon and is hiv+.  She has been seeking information from all sources available to her to investigate the possibility of treating her milk to make it 'safe'.
Last week the woman called a round table meeting with the paediatrician, GP, her husband, and a couple of others including yours truly. 

It was an interesting meeting.  The woman had stacks of information from professional publications, an e-mail from a senior microbiologist, milk banking &c&c, telling her that heating milk to 62C for 30 minutes (or 57, 58, 63, depending on which source) would destroy the virus.  She had found a fancy bottle warmer that has a thermostat which could be set to a particular temperature.  She planned to prepare milk ahead of time, one feed at a time.  However the medical experts argued that it was impossible to be SURE that the milk was safe.  There is no quick testing, and every sample could not be tested.  The opinion of these medicos was clearly that they could in no way support the plan to heat treat breast milk in the home.  The theoretical possibility of paediatric AIDS transmission in breastmilk completely outweighed the benefits.  The statement that "as a parent I could not sleep at night with that sort of risk" was made.

A second line of the discussion was what to do if the baby is born positive.  What would be recommended in that case?  The opinion of our experts was that any continued exposure to the virus (in this case through breastfeeding, or even this 'risky' plan of heat treated milk) could compromise the baby's treatment.  The analogy was drawn to hiv+ people who are advised to prevent ongoing exposure through unprotected sex, as the virus could change, and a further level of infection result.  

I felt that I had little to offer this woman.  I agree with her findings that there is a lot of confidence that hiv will be destroyed by heat.  However I think it is partly defensive practice that makes it almost impossible for a person in the paediatrician's position to offer support to a plan for 'uncontrolled' kitchen pasteurisation of milk.  If the baby became infected where would the 'blame' be put? 
I wonder?
I will be interested in the collective wisdom of the lactnet family.
Joy Johnston
Midwife and lactation consultant 
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www.webrider.net.au/~aitex/joy.htm


-----Original Message-----
From:   Marty & Jeanette Panchula [SMTP:[log in to unmask]]
Sent:   Thursday, April 30, 1998 7:36 PM
Subject:        HIV and breast milk

One of the Pediatricians I work with is a specialist in Pediatric AIDS.
Due to all the talk about the situation in Zimbabwe, we are considering
creating a study on the treatment that expressed breast milk would need for
an HIV+ mom to be able to give her own milk to her baby.

So - any suggestions on the different "home treatment"  possibilities which
would make the milk safe?  I realize that there is a shortage of fuel in
some areas of the world which would make boiling a difficult if not
impossible treatment.  What about reflector ovens?

Just asking you to brainstorm e-mailing directly to me - and we'll see
where this goes!



Jeanette Panchula, BSW, RN, IBCLC, LLLL
[log in to unmask]
Project Director - Proyecto Lacta - Puerto Rico
http://netdial.caribe.net/~prlacta/
Lactancia Materna '98 - La Mejor Inversion