HIV, Living With Community
Breast feeding
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Breast feeding

Hi.In which case is it better  for an HIV positive mother to breastfeed her baby?and for how long?
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10947_tn?1281407852
Response from H. Hunter Handsfield, MD

The discussion to date is consistent with current guidelines for
breastfeeding by HIV infected mothers, which vary widely between
industrialized and low income countries, and with availability of
antiretroviral therapy (ART).  Current recommendations (CDC, WHO/UNICEF) can
be found in the links below (the WHO link is different than the one cited by
Dr. Sanbos, but I believe they end up at the same document).

In brief, breastfeeding is not recommended in the US or other industrialized
countries. However, it will be interesting to see if CDC recommendations
change in the future; the research showing that ART with low viral loads
almost entirely prevents sexual transmission probably will lead to
reconsideration of the breastfeeding proscription by ART-treated mothers.

In developing countries, when mom has HIV and the baby is known or believed
to be uninfected, breastfeeding nonetheless is generally recommended during
the first 6 months of life, when the benefits of breastmilk over formula
(immunologic competence, protection against potentially fatal diarrheal
diseases, general improvement in health and growth) generally outweigh the
statistical likelihood of HIV transmission (10-15% risk during the first 6
months of life). However, as pointed out by others, specific recommendations
around these themes vary widely, depending on whether or not the baby is
known to be infected; availability of ART; and other factors.

In brief, one size does not fit all, even in developing countries.  In all
settings in both industrialized and developing countries, the central
strategy to prevent mother to child transmission of HIV is routine blood
tests during pregnancy, and ART for infected women through delivery and
thereafter. Happily, these strategies are increasingly practical in many
low-income countries, although there is a long way to go.

CDC guidelines:  
http://www.cdc.gov/breastfeeding/disease/hiv.htm
WHO guidelines:

http://www.who.int/hiv/pub/paediatric/infant_key_mess.pdf
Excellent overview:  
http://www.avert.org/hiv-breastfeeding.htm

Regards,

H. Hunter Handsfield, MD

Related Discussions
10 Comments Post a Comment
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Avatar_m_tn
HIV positive mother's don't breast feed their infants.
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1519485_tn?1318870773
the way for infants to get HIV from their mom's is for her to breastfeed. THAT IS THE FASTED TRANSMISSION TO YOUR CHILDREN
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1696352_tn?1318535967
Thank u v much for the reply..I think i was just hoping there was a new study that says otherwise.
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Avatar_m_tn
There hasn't been a study that says otherwise.
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1519485_tn?1318870773
HIV passes through breast milk very quickly.
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Avatar_dr_f_tn
Hi,
The WHO 2010 guidelines on HIV and infant feeding have shown that  national authorities promote breastfeeding and antiretroviral interventions where mothers known to be HIV-infected are now recommended to breastfeed their infants until at least 12 months of age. Evidence has been reported that ARV interventions to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of postnatal transmission of HIV through breastfeeding  ( ref: http://www.who.int/child_adolescent_health/documents/9789241599535/en/index.html)

There are several reading materials from this link that may help. However, it is best that you check with your doctor first for proper evaluation. Take care and regards.
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Avatar_m_tn
While the 2010 recommendations are generally consistent with the previous guidance, they recognize the important impact of ARVs during the breastfeeding period, and recommend that national authorities in each country decide which infant feeding practice, i.e. breastfeeding with an ARV intervention to reduce transmission or avoidance of all breastfeeding, should be promoted and supported by their Maternal and Child Health services. This differs from the previous recommendations in which health workers were expected to individually counsel all HIV-infected mothers about the various infant feeding options, and it was then for mothers to decide between them.

Where national authorities promote breastfeeding and ARVs, mothers known to be HIV-infected are now recommended to breastfeed their infants until at least 12 months of age. The recommendation that replacement feeding should not be used unless it is acceptable, feasible, affordable, sustainable and safe (AFASS) remains, but the acronym is replaced by more common, everyday language and terms. Recognizing that ARVs will not be rolled out everywhere immediately, guidance is given on what to do in their absence.
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Avatar_m_tn
While some HIV positive mothers in high-income countries may wish to breastfeed their child, the advice from national health agencies is straightforward: they should avoid breastfeeding altogether because the risk of HIV transmission far outweighs the risks associated with replacement feeding. Replacement (sometimes known as formula) feeding is the only infant feeding method that does not expose an infant to HIV and in regions of the world where clean water and facilities are available; it is usually promoted as the only option.

In some countries, including the UK and the USA, there is a possibility that HIV positive mothers who choose to breastfeed may be prevented from doing so, or may be charged with child endangerment if they persist. Nevertheless the UK Department of Health advises that:
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1696352_tn?1318535967
Hi,
thank u so much for the information.I thought i heard of the same thing few months ago but with these things you never know what to believe...
So i need to understand more...if a mother was on ARV by the time she conceived and her viral load is UNDETECTED through the pregnancy and after and baby put on ARV at birth...it still wont be 100% safe to breastfeed??Thank u for ur help.
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10947_tn?1281407852
Response from H. Hunter Handsfield, MD

The discussion to date is consistent with current guidelines for
breastfeeding by HIV infected mothers, which vary widely between
industrialized and low income countries, and with availability of
antiretroviral therapy (ART).  Current recommendations (CDC, WHO/UNICEF) can
be found in the links below (the WHO link is different than the one cited by
Dr. Sanbos, but I believe they end up at the same document).

In brief, breastfeeding is not recommended in the US or other industrialized
countries. However, it will be interesting to see if CDC recommendations
change in the future; the research showing that ART with low viral loads
almost entirely prevents sexual transmission probably will lead to
reconsideration of the breastfeeding proscription by ART-treated mothers.

In developing countries, when mom has HIV and the baby is known or believed
to be uninfected, breastfeeding nonetheless is generally recommended during
the first 6 months of life, when the benefits of breastmilk over formula
(immunologic competence, protection against potentially fatal diarrheal
diseases, general improvement in health and growth) generally outweigh the
statistical likelihood of HIV transmission (10-15% risk during the first 6
months of life). However, as pointed out by others, specific recommendations
around these themes vary widely, depending on whether or not the baby is
known to be infected; availability of ART; and other factors.

In brief, one size does not fit all, even in developing countries.  In all
settings in both industrialized and developing countries, the central
strategy to prevent mother to child transmission of HIV is routine blood
tests during pregnancy, and ART for infected women through delivery and
thereafter. Happily, these strategies are increasingly practical in many
low-income countries, although there is a long way to go.

CDC guidelines:  
http://www.cdc.gov/breastfeeding/disease/hiv.htm
WHO guidelines:

http://www.who.int/hiv/pub/paediatric/infant_key_mess.pdf
Excellent overview:  
http://www.avert.org/hiv-breastfeeding.htm

Regards,

H. Hunter Handsfield, MD

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