Determination of the effectiveness of inactivation of human immunodeficiency virus by Pretoria pasteurization

The risk of transmission of the human immunodeficiency virus (HIV) via breastfeeding is between 10 and 17 per cent. In resource-poor countries most HIV-infected women cannot afford to formula feed their infants and formula feeding is not desirable in areas of high infant mortality because of loss of the immunological benefits of breastmilk. A method has been devised by which HIV-infected women may express and pasteurize their breastmilk in a domestic setting using inexpensive apparatus and a simple technique. The method, Pretoria Pasteurization has been shown to be reliable under a wide range of conditions and maintains milk between 56 degrees and 62.5 degrees C for between 12 and 15 min. This study was devised to determine whether Pretoria Pasteurization effectively inactivates HIV in human milk. Samples of expressed breastmilk were obtained from a group of HIV-infected lactating women and a group of HIV-negative women. The samples of milk from the HIV-negative women were inoculated with high titres of cell-associated and cell-free HIV. Each sample was divided into a control portion and a study portion. The study portion underwent Pretoria Pasteurization. Control and pasteurized samples were inoculated into lymphocyte co-culture for a period of 35 days. All co-cultures were sampled weekly and analysed by serological and molecular methods for p24 antigen, cell-free HIV RNA and integrated DNA. Viral RNA was detected in the milk of 80 per cent amongst the known HIV-positive women. The mean serum viral load in the group of HIV positive women was 50728 copies/ml and the mean milk viral load was 422000 copies/ml. Evidence of viral replication was shown in 11 of the control specimens. There was no evidence of viral replication in any of the study specimens which had undergone Pretoria Pasteurization. It was concluded that Pretoria Pasteurization effectively inactivates HIV in human milk.