Breast Milk Sodium Concentrations
Fifty-five of 334 HIV-1-positive women and 15 of 96 HIV-1negative women had elevated sodium in breast milk consistent with mastitis 6 weeks after delivery . The characteristics of HIV-1positive women with and without elevated breast milk sodium concentrations are shown in . HIV-1positive women with elevated breast milk sodium concentrations consistent with mastitis had significantly fewer CD4+ lymphocytes and significantly higher plasma HIV-1 load, breast milk HIV-1 load, breast milk lactoferrin level, and rates of mother-to-child transmission of HIV-1 at 6 weeks and 12 months compared with women with normal breast milk sodium concentrations. There were no significant differences in maternal age, CD8+ lymphocyte count, CD4/CD8 ratio, or body mass index between mothers with elevated and normal breast milk sodium concentrations. Median breast milk HIV-1 load was 920 copies/mL among women with elevated breast milk sodium levels, compared with undetectable among women with normal breast milk sodium levels .
Breast milk human immunodeficiency virus load in women with elevated breast milk sodium levels consistent with mastitis and with normal breast milk sodium levels 6 weeks after delivery .
Breastfeeding And Herpes Simplex Virus
Herpes simplex virus is transmitted primarily through contact with an open sore or lesion. While HSV cannot be transmitted through breast milk, contact with sores on the nipples poses a serious risk to a newborn.
In such instances, mothers are advised bottle-feed their babies or use a breast pump so long as the equipment does not come into contact with a sore. Breastfeeding can be restarted once the sores are fully healed.
Susceptibility Of Blt Mice To Hiv
During mucosal transmission, HIV encounters several physical and immunologic barriers that allow only one to a few variants from a diverse donor pool to cross the mucosa and establish systemic infection . A better understanding of the molecular and biological determinants that bestow a selective advantage for mucosal transmission of these transmitted/founder viruses will aid the development of novel vaccines and other prevention strategies. Hence, our next objective was to determine if CCR5-tropic T/F viruses can establish a systemic infection in BLT mice following an oral exposure.
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Maternal Plasma Viral Load Monitoring
Despite increasing access to lifelong antiretroviral treatment, the coverage of plasma viral load monitoring during breastfeeding ranges from 38% to 98% in Global Plan priority countries.2933 Non-pregnant adult guidelines recommend six monthly viral load monitoring, but this may result in only 31% viral load testing coverage during pregnancy34 reasons for this include late antenatal booking, limited number of antenatal visits, underuse of routine maternal viral load monitoring, stigma, and inoperability of machines to measure viral load.3536
Since 2019, some low and middle income countries, such as South Africa, recommend viral load testing at antenatal care booking , at delivery, and then six monthly.37 If viral load is 1000 copies/mL or 500-< 999 copies/mL then counselling and repeat viral load testing are recommended 4-6 weeks or 8-10 weeks later, respectively. Infant antiretroviral prophylaxis is extended beyond six weeks or includes two drugs only if maternal viral load is 1000 copies/mL. However, mother-to-child transmission can occur when viral load is < 1000 copies/mL.37 Consequently, current recommendations would not eliminate the risk of breast milk transmission.
Who Has Come With New Infant Breastfeeding Guidelines For Hiv Positive Mothers And Here Is What You Should Know About It
Written by Debjani Arora | Published : December 5, 2017 3:43 PM IST
Till about a decade back it was believed that mother-to-child transmission of HIV can happen in three ways during pregnancy, labour and delivery or while breastfeeding. This is why HIV positive mothers who conceive and deliver babies when they are on antiretroviral therapy and other assisted procedures are asked not to breastfeed. Here is how to conceive a baby if both partners are HIV positive.
However, on 30 November 2009, World Health Organisation or WHO released new recommendations on infant feeding by HIV-positive mothers, based on new studies. For the first time, WHO recommended that HIV-positive mothers or their infants take antiretroviral drugs throughout the period of breastfeeding and until the infant is 12 months old. This means that the child can benefit from breastfeeding with a very little risk of becoming infected with HIV. However, there are studies which concluded that benefits of breast milk can override the risk of transmission of HIV virus, especially if the mother and baby are given ART in tandem.
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Getting Pregnant When A Male Partner Is Hiv
If a male partner is HIV-positive, a procedure called sperm washing can be used to conceive. During this procedure a machine separates sperm cells from the seminal fluid, which can carry the virus. The washed sperm is then used to fertilise the womans egg using a special catheter inserted into the uterus.
If the male partner is on effective treatment and has a stable undetectable viral load, there is no risk of HIV transmission.
In-vitro-fertilisation may also be an option.
Clinical Syndromes And Conditions
Appendix F lists a number of clinical syndromes, conditions, and organisms that require infection control precautions in hospitals. This appendix also includes short lists of possible etiologic agents for these conditions and appropriate precautions and recommendations concerning breastfeeding for different scenarios or organisms. This chapter considers specific infectious agents that are common, clinically significant, or of particular interest.
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What Are The Alternatives
If a person with HIV does not wish to breastfeed their newborn or is advised against doing so, other feeding options may include donor milk and formula.
Lactating women with additional breast milk can donate it for other mothers to use with their infants. Donor milk banks will screen this milk for safety.
Donor milk can be costly, so some people accept extra breast milk from friends or relatives instead. Because this milk is not screened, its not generally advised to participate in these exchanges.
Many babies around the world are exclusively formula fed. Parents can choose from a wide range of formulas with varying ingredients. Formula can be fed through bottles, spoons, and syringes.
Factors To Consider When Deciding
A few things that may factor into the safety of breastfeeding with HIV include:
- Antiretroviral therapy . Mothers with HIV should be receiving antiretroviral therapy consistently throughout their pregnancy and while breastfeeding to reduce the possibility of transmission.
- Maternal virus count. People with HIV who have undetectable viral loads may be able to breastfeed more safely.
- Other available feeding resources. Access to affordable, clean water, formula, or donor milk will influence whether breastfeeding is the best option for a person living with HIV.
and the American Academy of Pediatrics both advise against breastfeeding for mothers with HIV.
This is because people in the United States largely have reliable access to clean water and affordable replacement infant feeding methods.
In countries with limited resources, the CDC recommends that mothers with HIV receive ART and breastfeed their babies exclusively for the first 6 months.
At that point, breastfeeding should continue with the addition of solid food until 12 months.
La Leche League International, which offers local support groups for breastfeeding people across the globe, encourages those with HIV to seek out the most up-to-date recommendations based on the country in which they live.
In the United States, with consistent ART and monitoring, La Leche League encourages exclusive breastfeeding with support from lactation professionals for the first 6 months.
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Infant Feeding For The Prevention Of Mother
Mother-to-child transmission of HIV is the primary mode of HIV infection in infants. Transmission can occur during pregnancy, birth, or through breastfeeding. Decisions on whether or not HIV-infected mothers should breastfeed their infants is generally based on comparing the risk of infants acquiring HIV through breastfeeding, with the increased risk of death from malnutrition, diarrhoea and pneumonia if the infants are not exclusively breastfed.
Accumulating evidence has shown that giving antiretroviral medicines to the mother or the infant can significantly reduce the risk of HIV transmission through breastfeeding. National health authorities can refer to this evidence when formulating a strategy on infant feeding.
Managing Illness As A Parent
Although medical advances now allow people with HIV to live full, healthy lives, you may have times where you or your partner is unwell or needs medical care.
As with any longer-term illness, this can impact on your ability to earn an income, manage a household or raise children.
Living with chronic illness can be a challenge and sometimes families need extra support. Trying to sort things out on your own can make life seem overwhelming. Dont be afraid to ask for help from expert organisations that support people with HIV.
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What Is The Risk Of Transmission Through Infant Feeding
There are two possible routes of HIV transmission to an infant after birth through breastfeeding , and through feeding an infant food that has been pre-chewed by a parent or caregiver who has HIV .
Breastfeeding
A systematic review of HIV transmission in breastfed infants of women on treatment found that the risk of transmission after birth was 1% after six months of breastfeeding, rising to almost 3% after one year.15 However, within these studies, the women were on treatment for varying amounts of time and did not continue treatment beyond six months after giving birth. The systematic review did not account for adherence nor viral load, which means we dont know how many of the women had a detectable viral load at the time of transmission, despite taking HIV treatment.
There is very limited research on people on treatment who are breastfeeding that includes data on their viral loads. While an undetectable viral load does provide significant protection from HIV transmission, there have been cases of HIV transmission among breastfeeding women who had undetectable viral loads.16,17
A recent study from Tanzania reported no transmissions from breastfeeding women who had an undetectable viral load.18 In this study there were two HIV transmissions among 177 infants who were breastfed by women who started treatment before the infant was born, but in both cases the women had detectable viral loads.18
Pre-chewing food
Body Fluids That Transmit Hiv
What body fluids transmit HIV?
Only certain body fluids from a person who has HIV can transmit HIV. These fluids include
- blood,
- vaginal fluids, and
- breast milk.
These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream for transmission to occur. Mucous membranes are found inside the rectum, vagina, penis, and mouth.
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Preparation Of Humanized Blt Mice
Humanized BLT mice were prepared as previously described . Briefly, a 12 mm piece of human fetal liver tissue was sandwiched between two pieces of autologous fetal thymus tissue under the kidney capsule of sublethally irradiated 68 wk old NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ mice. Following implantation, mice were transplanted intravenously with hematopoietic CD34+ stem cells isolated from autologous human fetal liver tissue. Human immune cell reconstitution was monitored in the peripheral blood of BLT mice by flow cytometry every 34 weeks as previously described , , . Mice were maintained by the Division of Laboratory Animal Medicine under specific-pathogen free conditions at UNC-Chapel Hill.
Hiv And Getting Pregnant
If you are HIV-positive and become pregnant, or would like to have a baby, it is strongly recommended that you talk to specialists.
If you live in Victoria, The Victorian HIV Service at the Alfred Hospital and the Chronic Viral Illness Clinic at the Royal Womens Hospital can provide you with more information.
At the Chronic Viral Illness Clinic at the Royal Womens Hospital you can discuss your options with doctors who specialise in HIV and reproductive health.
This clinic specialises in helping serodiscordant couples to conceive safely.
Timing of sex to coincide with ovulation can be discussed with a healthcare provider to increase your chances of getting pregnant while reducing the risk of passing on the virus.
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Is It Safe To Take Hiv Medication In Pregnancy
Some medicines for HIV aren’t suitable to take during pregnancy.
If you have HIV and become pregnant, contact your local HIV clinic.
This is important because:
- some anti-HIV medicines can harm unborn babies, so your treatment plan will need to be reviewed
- additional medicines may be needed to prevent your baby getting HIV
But if you’re taking HIV medication and you become pregnant, do not stop taking your medication without first speaking to your GP.
Always check with your GP or midwife before taking any medicine when you’re pregnant.
What Choice Should I Make
You are the only person who should decide how your baby will be fed. If you choose to breastfeed, it is important to take your HIV drugs, and keep up with health care visits and viral load testing, exactly as prescribed and recommended by your provider. It is also very important to find a support network, including a providerand other allieswhom you trust, and who can be good sources for information without judgment.
Making this decision can be a challenging process. You may feel fear, stress, or even some sadness over any of the choices you are considering. It is also important to remember to take care of yourself during this process. It may be helpful to connect with a group of women or others who can offer support, to write about your thoughts and concerns, or to engage in some other activity that helps you feel supported as you prepare to make the best possible decision for you and your growing family.
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What Does The Science Say About Breast Milk And Hiv Transmission
30 years into the response, there are still a number of unanswered questions around the exact mechanism by which a baby can become infected via breast milk. There also remain questions about the viral load of HIV in blood versus the viral load in breast milk, and what a safe threshold is for transmission. This is why scientists and policymakers have yet to declare U=U for breastfeeding.
It is known that HIV particles and HIV-infected cells are present in breast milk, and there is a clear link between the mother having a high viral load and the baby becoming infected, which is why it is important for the mother to be on treatment while breastfeeding to reduce her viral load.
But a number of factors could also contribute to a baby becoming infected including the high percentage of latently-infected CD4 cells and other tissue cells such as macrophages and dendritic cells in breastmilk compared to blood. These cells can hide inactivated HIV in viral reservoirs which treatment cannot get to. These cells may be associated with mother-to-child transmission in women with or without suppressed viral loads, but we require more research to know exactly how they contribute to infection.
How Do You Get Or Transmit Hiv
You can only get HIV by coming into direct contact with certain body fluids from a person with HIV who has a detectable viral load. These fluids are:
- Blood
- Semen and pre-seminal fluid
- Rectal fluids
- Vaginal fluids
- Breast milk
For transmission to occur, the HIV in these fluids must get into the bloodstream of an HIV-negative person through a mucous membrane open cuts or sores or by direct injection.
People with HIV who take HIV medicine daily as prescribed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV-negative partners.
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Social And Economic Influences
Many women living with HIV described social pressure from family and community that impacted their infant feeding decision. Some mothers expressed they had to create stories for family members to justify why they were not breastfeeding:
She was very angry why I was not breastfeeding the baby, and I said no the breast doesnt pump, because I didnt want to tell her. I dont have a good relationship with my mother, so disclosing to her shell be very angry. So I said to her my milk doesnt come and the baby is already here at home, so there is nothing I can do I have to bottle feed the baby. And then after 4 to 5 days when I woke up she saw my breasts full with milk and she said but you said there is no milk and I said maybe it started today. And at the clinic they said if you are breastfeeding you must breastfeed from the first day and if you are bottle feeding you must bottle feed, so I said I am going to bottle feed all the way, but she was very angry. Woman living with HIV, age 27, formula feeding
Many mothers who chose to breastfeed cited the cost of formula as a driver for their decision:
I chose to breastfeed because I am not working and sometimes you may find that I would not have money to buy formula as the father also doesnt have a good job. -Woman living with HIV, age 31, breastfeeding
How Is Hiv Transmitted From Mother To Child During Pregnancy
If you are a pregnant woman living with HIV there are a number of ways that HIV might be passed on to your baby. HIV in your blood could pass into your babys body. This is most likely to happen in the last few weeks of pregnancy, during labour, or delivery. Breastfeeding your baby can also transmit HIV, because HIV is in your breastmilk.
There is a 15 to 45% chance of passing HIV on to your baby if neither of you take HIV treatment.
However, taking the correct treatment during your pregnancy and while you breastfeed can virtually eliminate this risk.
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