HIV infection breastfeeding and human milk banking [letter]

As far as milk banking is concerned your July 16 editorial is seriously flawed. Because of the immunological weakness of premature infants the dire effects of HIV infection and the large and possibly intense retroviral exposure that pooled milk can represent all precautions should be taken to make donated human milk safe. To suggest there is no need to know the HIV status of donors as the milk can be rendered safe by pasteurization breaches 2 widely accepted principles. Firstly in other tissue transfer situations the need for donor screening for anti-HIV is recognized; it is doubtful after an explanation whether women donating milk would wish to be treated differently. Secondly it is unusual in the prevention of transmission of infectious disease to rely on only 1 precaution. Reliance on a single measure is acceptable only if no other is available or if that 1 option is highly reliable. Neither applies here. Various measures are available and pasteurization alone as done in human milk banks and under the conditions you recommend would be insecure. The DHSS committee that considered human milk banking in 1981 recommended pasteurization at 62.7 degrees Celsius for 30 minutes. This probably gives the necessary margin of safety for a virus such as HIV which may be protected from heat when suspended in milk and the lack of infectivity of which ought not to be determined simply by absence of reverse transcriptase activity. The pasteurization temperatures you quote are too low to be confident of killing HIV even in favorable circumstances. You also ignore the possibility of failures in pasteurization. It is possible to run human milk banks in Britain virtually free of HIV risk as has been achieved for blood and semen banks. A wise approach to the use of donated human milk would be that it is used only when essential that it is taken only from screened low-risk donors and that it is pasteurized under carefully controlled conditions with an adequate safety margin. It might also be advantageous to limit pooling of donations. (full text)