United States – Women living with HIV have the right to breastfeed their children if their viral load is suppressed by antiretroviral therapy a leading professional association of pediatricians announced Monday in a dramatic reversal of position.
Improved Medications Reduce Risk of Transmission
The AAP has changed its stance on HIV exposure and transmission for infants since it issued its first guidelines in the early 1980s, as reported by Associated Press.
It acknowledges that the drugs that are regularly prescribed can bring the risk of passing HIV onto a child through breast milk down to below 1%, said pediatric HIV specialist Lisa Abuogi of the University of Colorado in Denver, who led the report.
“The medications are so good now, and the benefits for mom and baby are so important that we are at a point where it is important to engage in shared decision-making,” Abuogi said.
Shared Decision-Making Encouraged
These drugs are called antiretroviral therapy, and they do not completely uplift the risk of transmitting HIV through breast milk. Abuogi said the only sure way to avoid spreading the virus is to skip breastfeeding.
Also they will be required to exclusively breastfeed their babies for the first six months since research indicates that alternate feeding between breast milk and formula can negatively upset an infant’s intestines and this can put the infant at risk of contracting HIV.
Each year in the U. S., approximately 5000 HIV-infected women deliver babies. Abuogi said almost all of them take drugs to keep the viral load at very low levels but that the load can increase if they are not compliant with their drugs.
In the past when the medicines began to be made commercially available a decade ago approximately 30% of HIV infections passed from moms to newborns through breastfeeding said Dr. Lynne Mofenson an adviser to the Elizabeth Glaser Pediatric AIDS Foundation. About two thousand infections used to occur in infants in the United States alone every year during the early 1990s. Now, it is less than 30.
The AAP policy was issued over one year after the National Institutes of Health and the Centers for Disease Control and Prevention withdrew long-standing guidelines against breastfeeding by HIV-positive individuals. That guidance counseled people who have consistent viral suppression on their options. It also highlights that healthcare providers should not report to child protective services agencies if a parent with HIV intends to breastfeed.
The intent is to listen to patients, not blame or shame them,” said Northwestern University professor of obstetrics and gynecology Dr. Lynn Yee, who helped draft the NIH guidance.
Recent studies link breastfeeding exclusively with babies getting the best nutrients and immunity against diseases like obesity and Type 2 diabetes. Nursing also helps the mother to reduce her risk of developing breast as well as ovarian cancer as well as diabetes and high blood pressure.
Since 2010, the WHO has advised women with HIV in developing countries to breastfeed their infants and receive antiretroviral therapy. The guidance balanced the risk of infants getting HIV through breastfeeding and the risk of dying from malnutrition, diarrhea, and pneumonia in places where there are no substitutes for breast milk that is safe.
In developed nations, experts had advised against it because, with safe water formula and human donor milk at hand, the risk of HIV transmission could be entirely eliminated, as Yee says.
Which angered people with HIV who, in turn, were completely denied the choice of nursing.
Challenges and Success Stories
Ci Covin, 36, of Philadelphia, said she was informed that she had HIV at 20 years old and denied breastfeeding her firstborn son Zion, who is now 13 years old.
“I couldn’t understand how come my sister, who lives in a place like Kenya, who looks just like me with the same color brown skin, was given the option to breastfeed and how my option was starkly no,” she said.
Unable to breastfeed her son pushed Covin into a postpartum depression, she says. After she conceived her current 2-year-old daughter Zuri, her healthcare providers were able to assist her in successfully breastfeeding for seven consecutive months. Covin followed the doctor’s instructions by taking her prescriptions on time and also gave the baby drugs to prevent infection.
“Breast milk has everything in it that my baby would need,” Covin said. “That’s a beautiful thing.”
Support for Providers and Patients
Abuogi added that the AAP report can be essential for pediatricians, nurses, and lactation specialists who are associated with children and family care.
It is a fact that some providers were already assisting the people treated for HIV to deliver and take care of their babies, even against the earlier recommendations. It should increase the practice perhaps sooner than later Abuogi said, as reported by Associated Press.
“This is a unique situation because it’s not just doctors and providers who are changing,” Abuogi said. “Our patients are pushing this as well.”
