Thanks Sue, for being willing to take on the task
of correcting the myth-information in the First Five info booklet for mothers.
There is a problem with this statement:
"Absolutely do not breastfeed your baby if: You are HIV-positive or have AIDS"
The AAP have set out very clear guidance on HIV
and infant feeding which - while it makes a first
recommendation for no breastfeeding, then goes on
to recognize that some HIV+ mothers may wish to
do so, and when that happens they should be
supported to breastfeed in as safe a manner as
possible. It's very cleverly done and follows
current WHO HIV and infant feeding
recommendations stressing that when an HIV+
mother receives effective antiretroviral
treatment to reduce her viral load to
undetectable, when she is adherent to her
medications and when she exclusiv ely breastfeeds
for the first six months of life, the risk of
transmission of the virus to her baby is
extremely low, at 0-1%. As you will know, in the
US, there is mandatory testing in pregnancy, and
mothers diagnosed as HIV-positive will receive
ART during pregnancy and for life:
So in the first paragraph of the current AAP
guidance on HIV and infant feeding, set out in
Pediatrics 2013;131:391–396, they state:
"Because the only intervention to completely
prevent HIV transmission via human milk is not to
breastfeed, in the United States, where clean water and
affordable replacement feeding are available, the
American Academy of Pediatrics recommends that
HIV-infected mothers not breastfeed their
infants, regardless of maternal viral load and antiretroviral therapy."
However, on the second page of the guidance, it goes on to say:
"An HIV-infected woman receiving effective
antiretroviral therapy with repeatedly
undetectable HIV viral loads in rare
circumstances may choose to breastfeed despite
intensive counseling. 20 This rare circumstance
(an HIVinfected mother on effective treatment and
fully suppressed who chooses to breastfeed)
generally does not constitute grounds for an
automatic referral to Child Protective Services
agencies. Although this approach is not
recommended, a pediatric HIV expert should be
consulted on how to minimize transmission risk,
including exclusive breastfeeding. Communication
with the mother’s HIV specialist is important to
ensure careful monitoring of maternal viral load,
adherence to maternal therapy, and prompt
administration of antimicrobial agents in
instances of clinical mastitis. Infant HIV
infection status should be monitored by nucleic
acid (plasma HIV RNA or DNA) amplification
testing throughout lactation and at 4 to 6 weeks and 3 and 6 months
after weaning."
For the full text, please see American Academy of
Pediatrics, Committee on Pediatric AIDS, Infant
feeding and transmission of HIV in the United
States, COMMITTEE ON PEDIATRIC AIDS, Pediatrics
2013; 131:2 391-396; published ahead of print
January 28, 2013, doi:10.1542/peds.2012-3543,
Available at
<http://pediatrics.aappublications.org/content/early/2013/01/23/peds.2012-3543.full.pdf+html>http://pediatrics.aappublications.org/content/early/2013/01/23/peds.2012-3543.full.pdf+html
See also published E-responses
at
<http://pediatrics.aappublications.org/content/131/2/391.short#responses>http://pediatrics.aappublications.org/content/131/2/391.short#responses
For exhaustive background and loads of refs, see
the 2012 WABA HIV Kit at www.hivbreastfeeding.org
Warm regards
Pamela Morrison IBCLC
Rustington, England
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