by Anne Eglash MD, IBCLC, FABM
In 2016 the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) updated their guideline on infant feeding for mothers who live with Human Immunodeficiency Virus (HIV). Areas of the world with high HIV rates are more prone to high child mortality rates. The high child mortality rates can be decreased by exclusive breastfeeding during the first 6 months.
The last guidelines from UNICEF and WHO on maternal HIV and infant feeding were published in 2010. At that time, the guidelines recommended that mothers living with HIV should receive lifelong antiretroviral treatment to reduce HIV transmission thru breastfeeding. For settings where mothers are supported with ongoing antiretroviral therapy, breastfeeding mothers were encouraged to exclusively breastfeed their infants during the first 6 months of life, with the addition of complementary foods and continued breastfeeding for the first 12 months of life. The 2016 guidelines update this recommendation, encouraging mothers living with HIV who are fully supported with antiretroviral therapy to breastfeed for at least 12 months and may continue to breastfeed for up to 24 months or longer, similar to the general population.
Which statement is accurate within the 2016 Guideline Updates on HIV and Infant Feeding by UNICEF and WHO?
- Mothers living with HIV who take anti-retroviral therapy should not breastfeed if they mix feed, meaning that they give their babies formula and breastmilk in the first 6 months.
- A breastfeeding mother living with HIV who takes anti-retroviral therapy should not breastfeed if she plans to only nurse for 3 months.
- Mothers living with HIV who do not have access to anti-retroviral medication are safe to express and heat-treat their breastmilk for their babies.
- Infants who live with HIV must avoid the bacteria in breastmilk, so they require pasteurized breastmilk or formula.
See the Answer
Read the reference:
UNICEF and WHO 2016 Guideline Updates on HIV and Infant Feeding
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
The UNICEF and WHO Infant Feeding and HIV Guidelines clearly state that every nation or sub-nation should decide how they will adopt these guidelines for their population. Some countries may decide to advise that breastfeeding mothers living with HIV avoid all breastfeeding in order to minimize the infant’s risk of HIV acquisition through breastmilk.
In the United States, the 2013 American Academy of Pediatrics Committee on Pediatric AIDS recommends that HIV-infected mothers not breastfeed their infants, regardless of maternal viral load and antiretroviral therapy. Despite this recommendation, in the body of the policy statement, the authors write ‘An HIV-infected woman receiving effective antiretroviral therapy with repeatedly undetectable HIV viral loads in rare circumstances may choose breastfeeding despite intensive counseling. This rate circumstance generally does not constitute grounds for an automatic referral to Child Protective Services’.
The United States Department of Health and Human Services also has the same recommendation, advising that breastfeeding mothers living with HIV refrain from breastfeeding their infants.
However, the National Institutes of Health published a news release in July 2016 regarding the PROMISE study (Promoting Maternal and Infant Survival Everywhere) which found that a three-drug antiretroviral regimen taken by mothers while breastfeeding virtually eliminates HIV transmission by breastmilk to their infants. This was a large study involving 2431 HIV-infected mothers and their HIV-uninfected infants in several countries in Africa between June 2011 and October 2014. They found the transmission rate of HIV among these exclusive breastfeeding babies to be 0.3% at 6 months and 0.6% at 1 year.
I personally hope that this strong evidence is used by clinicians in the United States to support mothers in the USA who are living with HIV and who want to breastfeed their babies. Although we live in a resource rich country with access to alternative feeding methods, breastfeeding is still the gold standard for infant nutrition in the USA as well as in other parts of the world.