Breastfeeding in mothers with HIV

Autor: Tony Walls, Jennie Studdert, Kieran T. Moran, John B. Ziegler, Pamela Palasanthiran
Rok vydání: 2010
Předmět:
Zdroj: Journal of Paediatrics and Child Health. 46:349-352
ISSN: 1440-1754
1034-4810
DOI: 10.1111/j.1440-1754.2010.01791.x
Popis: As paediatricians, we advocate for breastfeeding as the most beneficial form of infant nutrition. However, when the mother has human immunodeficiency virus (HIV), infection breastfeeding can potentially harm the infant because of mother-to-child transmission (MTCT) of the virus. The first documented case of MTCT of HIV through breastfeeding occurred in Australia in 1983. The World Health Organisation (WHO) estimates that more than 200 000 of the 500 000 new HIV infections that occur each year in children are the result of transmission of the virus through the mother’s breast milk. For many HIV-infected women in resource-poor countries, there is no safe alternative to breastfeeding available. The WHO currently recommends that where there are no affordable, safe, acceptable alternatives, HIV-infected women should exclusively breastfeed their children up to the age of six months and then wean rapidly. In resource-poor countries, this reduces infant mortality irrespective of the mother’s HIV status. This is in contrast to the developed world where interventions to prevent MTCT generally include maternal highly active antiretroviral therapy (HAART) during pregnancy, elective caesarean section and avoidance of breastfeeding, reducing transmission to 1–2%. We recently were involved in the antenatal care of a woman with HIV infection who was clinically well (CD4+ count of greater than 500 ¥ 10/mL), who had commenced HAART during pregnancy as part of a MTCT risk reduction strategy and who had an undetectable viral load. When discussing with her our recommendations for infant feeding (i.e. that all infants of HIV-positive mothers should be formula-fed), it became apparent that she intended to breastfeed her infant. We took the view that we had a duty of care to protect the infant from potential exposure to HIV and strongly recommended that the infant should not receive breast milk. What is the evidence to support our recommendations? Is the risk to the infant sufficient to justify taking action to protect the child from exposure to HIV in breast milk?
Databáze: OpenAIRE
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