My thanks to the Milk Mob for putting together such an up-to-date and sane interpretation of current national (US) and international (WHO) guidelines. And for including the excellent latest results from the PROMISE study. Pamela Morrison IBCLC Rustington, England ---------------------------------------- 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 <http://pediatrics.aappublications.org/content/131/2/391> 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 <https://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/187/infant- antiretroviral-prophylaxis>, 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) <https://www.niaid.nih.gov/news/newsreleases/2016/Pages/PROMISE-results.aspx > 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. ----- posted for The Milk Mob by Allison Laverty Montag IBCLC Education Coordinator www.themilkmob.org *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome