Carol:  Thought I'd share with you some of what I've learned in
researching a presentation I just gave at a local LLL conference about
viral transmission in human milk.  The earliest the baby's status can be
confirmed at this time appears to be 3-6 months, although some PCR tests
may be able to detect infection as early as 4 weeks.  Apparently, before 4
weeks, either there isn't enough virus in baby's bloodstream (the PCR test
is done on peripheral mononuclear blood cells), or the virus is
sequestered in the baby's lymphoid tissue.
The testing of the mother's milk, unfortunately, is not realistic.  I was
planning to perform a study on HIV+ mothers' milk, checking the HIV in
freshly expressed milk and then rechecking it after several types of
treatment. I contacted researchers who have actually studied HIV
and human milk, and was informed that it is incredibly difficult to
culture HIV from human milk, probably because of all the antiviral stuff
in the milk.  In fact, a number of studies were done by adding HIV virus
to expressed milk.  Cell-free HIV has only been isolated from infected
mothers' milk in two studies, and intracellular HIV with great difficulty.
Also, if tests like PCR which detect proviral DNA are
positive, that doesn't necessarily mean the milk is infective.
Bottom line: if this mother wants to heat treat, she should trust in the
ample evidence that HIV is an extremely heat-sensitive virus, and forget
about testing her milk.  Regards, Alicia Dermer, MD, IBCLC.