Regine - my apologies for the delay in replying to your post on the
possibility of an HIV+ mother providing her own milk for her baby.

Yes, you are quite right, the UNAIDS HIV and Infant Feeding Guidelines
includes the possibility of pasteurization (holding the milk at 62.5 degrees
C for 30 minutes) to inactivate the virus.  This was researched by Orloff et
al, and reported in the JHL 1993, but this might be difficult for a mother
to do at home.

The possibility of an HIV+ mother providing her own boiled breastmilk for
her baby seems very feasible.  It seems that the virus is heat-labile and
that briefly bringing the milk to the boil would kill the virus, so that the
cooled milk could safely be fed to the baby.  Dr Felicity Savage King seems
to have been the first to have suggested this in her book, "Helping Mothers
Breastfeed". The Zimbabwe National HIV and Infant Feeding Guidelines have
also included this as the *first* choice of "replacement feeding" if an HIV+
mother chooses not to actually breastfeed her baby.

A mother wishing to provide EBM for an extended time would use the same
methods as we use for providing EBM to a premie baby - frequent, thorough
expressing/pumping from 6 hours after delivery, preventing any hint of
engorgement, and just continuing to drain the breasts well.  Some time ago
Lactnetters sent me some amazing case histories from their files of mothers
providing EBM for babies in special situations - sometimes for months, and
sometimes for years (thank you ladies), so we know it can be done.

Would boiling "change" the milk?  Probably.  But surely boiled human milk is
still nutritionally superior and more physiologically suited to the needs of
the human infant than the pasteurized, air-dried, powdered, reconstituted,
cow's-milk and heaven-knows-what-else mix which we call "formula" and
currently feed to babies without a qualm?  The protein is still *human*
protein, and will not give rise to allergies, and even though the milk is
boiled it will still retain some of its anti-infective properties, most
notably the fats.

Would I recommend this method of feeding for the baby of an HIV+ mother?
Yes! The next issue of Breastfeeding Review will have an article about this.
Best wishes to this brave mother, who obviously wants to give her baby the
very "best".  Incidentally, there was a paper (Coutsoudis et al, Lancet,
August this year) which showed that babies who were *exclusively* breastfed
by HIV+ mothers had a *lower* rate of transmission, on average, at three
months, than babies who were never breastfed.  The possibility has been put
forward that breastfeeding may provide a protective factor against virus
acquired at delivery.

Pamela Morrison IBCLC, Zimbabwe
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