Effects of lipolysis or heat treatment on HIV-1 provirus in breast milk.
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.


OBJECTIVE
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.
Chantry
C J
CJ
Department of Pediatrics, University of California Davis, Sacramento, California, USA. caroline.chantry@ucdmc.ucdavis.edu
Morrison
P
P
Panchula
J
J
Rivera
C
C
Hillyer
G
G
Zorilla
C
C
Diaz
C
C
D000328:Adult; D001942:Breast Feeding / Q000009:adverse effects*; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D015658:HIV Infections / Q000635:transmission* / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006358:Hot Temperature; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008066:Lipolysis; D008895:Milk, Human / Q000821:virology*; D011247:Pregnancy; D011533:Proviruses / Q000302:isolation & purification*; D014766:Viremia / Q000821:virology
D004279:DNA, Viral