A number of interventions have been proposed to reduce transmission from breastfeeding in resource-poor settings. These include supplementation, treatment of milk, and medical interventions.

Women who take a daily multivitamin excluding vitamin A can reduce death and prolong HIV-free survival significantly among their breastfed children. In contrast, vitamin A supplements have been associated with increased breastfeeding transmission of HIV.^[1]

A number of methods of treating breastmilk to remove the HIV transmission risk are under investigation and may be an especially important option during periods of increased risk of transmission, such as when the mother has cracked nipples or breast abscesses. All of these techniques require expression of breastmilk, which requires the women to be taught how to express breast milk to avoid mastitis, maintain proper hygiene, and to sustain this process for long periods. Issues of stigma may also need to be addressed by counselling.^[2]

Free and cell-associated HIV levels are reduced substantially if subjected to heat at 62.5°C for 30 minutes.^[3]. Solar Innovation in Denmark has developed a pasteurisation device that can be powered by electricity or solar energy.^[4] However, simple heating methods including flash boiling and 'Pretoria pasteurisation' can be carried out by mothers at home, with good results, in terms of reducing HIV levels significantly without destroying nutrients.^[5][6]

However, a disadvantage of heat treatment is that it reduces the immunoglobulins and other protective components of breast milk. Several studies have reported that naturally occurring anti- HIV factors in milk can also inactivate the virus if it is left to stand at room temperature for 30 minutes, but these methods need to be evaluated prospectively to determine whether they reduce HIV transmission through breastfeeding.

Another possibility is the use of immunoglobulin in breastfeeding women. Immunisation with virus-specific antibodies has been demonstrated to prevent transmission of similar animal viruses to HIV in some studies. For example, ACTG 185 showed that immunisation with HIV antibodies throughout pregnancy, and to the infant at birth coupled with AZT (zidovudine, Retrovir) treatment, produced an unexpectedly low rate of transmission.