Breastfeeding Among People With Human Immunodeficiency Virus in North America: A Multisite Study.

Autor:	Levison J; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA., McKinney J; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA., Duque A; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA., Hawkins J; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA., Bowden EVH; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA., Dorland J; Department of Obstetrics and Gynecology, University of Texas at Austin Dell Medical School, Austin, Texas, USA., Bitnun A; Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada., Kazmi K; Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada., Campbell DM; Department of Pediatrics, University of Toronto, St. Michael's Hospital, Toronto, Canada., MacGillivray J; Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada., Yudin MH; Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada., Powell A; Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Datta S; Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Abuogi L; Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA., Weinberg A; Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA., Rakhmanina N; Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA., Mareuil JW; Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA., Hitti J; Department of Maternal Fetal Medicine, University of Washington School of Medicine, Seattle, Washington, USA., Boucoiran I; Department of Obstetrics and Gynecology, University of Montreal/Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada., Kakkar F; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada., Rahangdale L; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA., Seidman D; Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, USA., Widener R; Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Nov 17; Vol. 77 (10), pp. 1416-1422.
DOI:	10.1093/cid/ciad235
Abstrakt:	Background: In North American countries, national guidelines have strongly recommended formula over breastmilk for people with human immunodeficiency virus (HIV) because of concern for HIV transmission. However, data from resource-limited settings suggest the risk is <1% among virally suppressed people. Information regarding breastfeeding experience in high-resource settings is lacking. Methods: A retrospective multisite study was performed for individuals with HIV who breastfed during 2014-2022 in the United States (8 sites) and Canada (3 sites). Descriptive statistics were used for data analysis. Results: Among the 72 cases reported, most had been diagnosed with HIV and were on antiretroviral therapy prior to the index pregnancy and had undetectable viral loads at delivery. Most commonly reported reasons for choosing to breastfeed were health benefits, community expectations, and parent-child bonding. Median duration of breastfeeding was 24 weeks (range, 1 day to 72 weeks). Regimens for infant prophylaxis and protocols for testing of infants and birthing parents varied widely among institutions. No neonatal transmissions occurred among the 94% of infants for whom results were available ≥6 weeks after weaning. Conclusions: This study describes the largest cohort to date of people with HIV who breastfed in North America. Findings demonstrate high variability among institutions in policies, infant prophylaxis, and infant and parental testing practices. The study describes challenges in weighing the potential risks of transmission with personal and community factors. Finally, this study highlights the relatively small numbers of patients with HIV who chose to breastfeed at any 1 location, and the need for further multisite studies to identify best care practices. Competing Interests: Potential conflicts of interest. A. W. reports research funding from NIH and GlaxoSmithKline; consulting fees for advisory board roles with GlaxoSmithKline, Seqirus, and Merck; and payment or honoraria from GlaxoSmithKline (for a podcast) and Merck (meeting presentation). I. B. reports grants or contracts with the Canadian Institutes for Health Research, NIH, Altona, Moderna, and Ferring; consulting fees from Pfizer; and a role with the Society of Obstetricians and Gynecologists of Canada. J. D. reports travel support from the American College of Obstetricians and Gynecologists for the national conference. A. P. reports support from NIAID (grant number K23AI155296) and royalties from UpToDate. K. K. reports meeting honoraria from Takeda Canada. L. A. reports grants or contracts from NIH and the Colorado Department of Public Health and Environment. L. R. reports consulting fees from the University of California, San Francisco Clinicians Consultation Center National Perinatal HIV Hotline. F. K. reports salary support from FRQS and research infrastructure support from the Quebec government (Ministère de la Santé et des Services Sociaux/Service de lutte contre infections transmissibles sexuellement et par le sang). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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