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Alternative Modified Infant-Feeding Practices to Prevent Postnatal Transmission of Human Immunodeficiency Virus Type 1 Through Breast Milk: Past, Present, and Future

Department of Bioscience and Biotechnology at Drexel University in Philadelphia, Pennsylvania

Cheston M. Berlin, MD

Pennsylvania State Children’s Hospital, Pennsylvania State Milton S. Hershey Medical Center in Hershey, Pennsylvania

Mary K. Howett, PhD

Department of Bioscience and Biotechnology of Drexel University in Philadelphia, Pennsylvania

Preventing mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) through breastfeeding is important to reduce the number of infected children. Research on making breastfeeding safer is a high priority. The authors reviewed the attempts to develop alternative methods, other than antiretroviral (ARV) therapy of mothers and/or babies, to decontaminate breast milk of infectious HIV-1 (free and associated with lymphocytes). They also review how these methods affect milk constituents, as well as their current and prospective status. A PubMed search for English publications on methods to prevent MTCT through breast milk was completed. Methods that have been tested, other than systemicuse or ARV or immunoprophylaxis, to reduce or prevent MTCT of HIV-1 through breast milk were broadly classified into 5 groups: (1) modified feeding practices, (2) heat treatment of milk, (3) lipolysis, (4) antimicrobial treatment of the breastfeeding mother, and (5) microbicidal treatment of infected milk. Their advantages and disadvantages are discussed, as well as future directions in the prevention of MTCT through breastfeeding.

Key Words: breast milk • breastfeeding • human immunodeficiency virus type 1 • HIV-1 • prevention • mother-to-child transmission (MTCT) • microbicides • sodium dodecyl sulfate (SDS) • heat treatment

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