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

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