Each week, The Milk Mob puts out a clinical question. Our hope is that we
can use the question to stimulate conversation! This week's question is
about Maternal HIV and Breastfeeding. The answer will be at the bottom of
the post.

Would you like to join in?
Maternal HIV and Breastfeeding

September 6, 2016

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)
<http://apps.who.int/iris/bitstream/10665/246260/1/9789241549707-eng.pdf>.
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?

   1. 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.
   2. A breastfeeding mother living with HIV who takes anti-retroviral
   therapy should not breastfeed if she plans to only nurse for 3 months.
   3. 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.
   4. Infants who live with HIV must avoid the bacteria in breastmilk, so
   they require pasteurized breastmilk or formula.

Scroll down for the answer....





The answer is #3
Read the reference:
UNICEF and WHO 2016 Guideline Updates on HIV and Infant Feeding
<http://apps.who.int/iris/bitstream/10665/246260/1/9789241549707-eng.pdf>

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