HIV-positive people can breastfeed their babies as long as they take medications that effectively suppress the virus that causes AIDS, a leading group of U.S. pediatricians said Monday, prompting a dramatic change in guidelines.
The new report from the American Academy of Pediatrics (AAP) reverses recommendations that have been applied since the beginning of the HIV epidemic in the 1980s.
The organization recognizes that routinely prescribed medications can reduce the risk of transmitting HIV through breast milk to less than 1%, said Dr. Lisa Abuogi, an expert on childhood HIV at the University of Colorado and lead author of the study. report.
“The medications are so good now and the benefits for mother and baby are so substantial that we are at a point where it is important to participate in shared decision making,” Abuogi added.
The drugs, known as antiretroviral therapy, do not completely eliminate the risk of transmitting HIV through breast milk. Avoiding breastfeeding is the only safe way to prevent transmission of the virus, Abuogi said.
Parents should exclusively breastfeed their infants for the first six months because research has shown that switching from breast milk to formula can alter the infant's gut in ways that increase the risk of HIV infection.
The new guidelines
About 5,000 HIV-positive people give birth each year in the United States. According to Abuogi, almost all of them take drugs to suppress the virus to very low levels, although viral levels can rebound if they do not continue taking them.
Before these drugs became widely used a decade ago, about 30% of HIV infections passed from mothers to children occurred during breastfeeding, according to Dr. Lynne Mofenson, a consultant at the Elizabeth Glaser Pediatric AIDS Foundation.
In the early 1990s, there were about 2,000 infections a year in American babies. Today, there are less than 30.
The new AAP policy comes more than a year after the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) rescinded long-standing recommendations against breastfeeding in people with HIV.
According to these guidelines, people with sustained viral suppression should be counseled about their options. It also emphasizes that health care providers should not alert child protective services if a parent with HIV attempts to breastfeed their child.
The goal is to listen to patients “and not blame or shame them,” said Dr. Lynn Yee, a professor of obstetrics and gynecology at Northwestern University, who helped write the NIH guideline.
Breastfeeding provides ideal nutrition for babies and protects them against diseases and conditions such as obesity and type 2 diabetes, studies show. Breastfeeding also reduces the risk of breast and ovarian cancer, diabetes and hypertension.
Since 2010, the World Health Organization (WHO) has recommended that HIV-positive women in developing countries breastfeed their children and have access to antiretroviral therapy.
The guidelines were adopted after weighing the risk of babies acquiring HIV through breastfeeding and the risk of them dying from malnutrition, diarrhea and pneumonia in places where safe breast milk substitutes are not available.
“Breast milk has everything my baby needs”
In developed countries, however, experts had advised against breastfeeding because the wide availability of clean water, formula and donor human milk could eliminate the risk of HIV transmission, Yee explained.
That frustrated people with HIV who were flatly denied the option to breastfeed.
Ci Ci Covin, 36, who lives in Philadelphia, said she was diagnosed with HIV at age 20 and was not allowed to breastfeed her first child, Zion, who is now 13.
“I couldn't understand how my sister, who lives in a place like Kenya, who looks like me and has the same brown skin color, was given the option to breastfeed and I was flatly denied,” she complained.
Not being able to breastfeed her son sent Covin into a spiral of postpartum depression. When she became pregnant with her daughter Zuri, who is now two years old, her healthcare team helped her breastfeed successfully for seven months. Covin took her prescriptions as directed and also gave the baby medication to prevent infections.
“Breast milk has everything my baby needs,” Covin added. “It is something wonderful”.
Abuogi said the AAP report provides crucial guidance for pediatricians, nurses and lactation specialists who work directly with children and families.
Some providers were already helping people treated for HIV breastfeed their babies, despite previous recommendations. The new guidance should expand the practice, hopefully quickly, Abuogi added.
“This is a unique situation, because it's not just doctors and providers who are changing,” Abuogi said. “Our patients are driving it too.”
