title: Flash-heat inactivation of HIV-1 in human milk: a potential method to reduce postnatal transmission in developing countries.
abstract: 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 HIV-positive 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 cell-free 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.
authors.affiliation: Division of Epidemiology, School of Public Health, University of California, Berkeley, CA 94720-7360, USA. ballardk@berkeley.edu
authors.forename: Kiersten
authors.initials: K
authors.lastname: Israel-Ballard
authors.forename: Richard
authors.initials: R
authors.lastname: Donovan
authors.forename: Caroline
authors.initials: C
authors.lastname: Chantry
authors.forename: Anna
authors.initials: A
authors.lastname: Coutsoudis
authors.forename: Haynes
authors.initials: H
authors.lastname: Sheppard
authors.forename: Lindiwe
authors.initials: L
authors.lastname: Sibeko
authors.forename: Barbara
authors.initials: B
authors.lastname: Abrams
mesh_terms: D000328:Adult; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1 / Q000302:isolation & purification; D006358:Hot Temperature; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016015:Logistic Models; D008895:Milk, Human / Q000821:virology*; D015999:Multivariate Analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D038301:Virus Inactivation