Taking Antiretroviral Treatment To Protect Your Baby
Taking treatment properly can reduce the risk of your baby being born with HIV to less than 1%.
If you knew that you were HIV-positive before you got pregnant, you may be taking treatment already. If you are not, talk to a healthcare professional about starting treatment as soon as possible.
If you found out that you living with HIV during your pregnancy, it is recommended that you start treatment as soon as possible and continue taking it every day for life.
Your baby will also be given treatment for four to six weeks after they are born to help prevent an HIV infection developing.
Safety Of Maternal And Infant Use Of Antiretroviral Drugs During Breastfeeding
A systematic data review showed a decrease in maternal bone mineral content among breastfeeding mothers who were receiving TDF-based ART compared to mothers who received no ART, but whether this condition persisted after discontinuation of breastfeeding was not known.40 The clinical significance of the reduced bone mineral density is uncertain. Subsequent studies in Africa have shown TDF-based ART to be associated with a decrease in bone mineral density during lactation. In one study, bone mineral density decline through 74 weeks postpartum was greater in breastfeeding women with HIV receiving TDF than in those receiving ZDV-based ART.41 A second study comparing bone mineral density in women with HIV receiving TDF-based ART to women without HIV showed accelerated loss during lactation, with only partial recovery by 3 months after cessation of lactation.42
Likewise, the rates of serious adverse events among infants who receive extended ARV prophylaxis during breastfeeding are low. In one study, the rate of adverse events in infants receiving 6 months of NVP was not significantly different from the rate in infants receiving placebo. A second study that compared two infant ARV prophylaxis regimens found no significant difference between the rates of adverse events among infants receiving the two regimens.22-24,27 Studies to date have examined only short-term adverse events, and few data are available on whether there might be long-term consequences of these drug exposures.
What Is The Real Risk Of Hiv Transmission
In scenarios where women do not have access to antiretroviral treatment, up to 20% of infants will become infected with HIV through breastfeeding if they werent already infected during pregnancy or childbirth. Where treatment is available, this risk can be reduced to below 1% in the real world.
So despite the many unanswered scientific questions, we do know the actual risk of HIV transmission is extremely low when the mother has access to suppressive ART.
The PROMISE trial in southern Africa found the transmission risk when the mother was on combination ART to be as low as 0.3% at 6 months, and 0.7% at 12 months. In another meta-analysis of six studies in low-income settings where mothers started treatment before or during pregnancy, post-natal HIV transmission rates of 1.08% were estimated at 6 months, with higher rates from mothers who started ART in the later stages of pregnancy .
According to researchers in a recent Lancet viewpoint, most of the cases of mother-to-child transmission during breastfeeding can be partly explained by either detectable virus or poor adherence.
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Hiv During Pregnancy And Childbirth
Women living with HIV who are on treatment and have a stable undetectable viral load are extremely unlikely to transmit HIV to their baby during pregnancy and childbirth. There is a 1 in 1000 chance of transmitting HIV to the baby during pregnancy and delivery, when a woman is on antiretroviral treatment and has a viral load below 50 copies/ml .
HIV-positive women who are on treatment and have stable undetectable viral load, have a 1-2% chance of transmitting HIV to their baby if they breastfeed for 12 months.
So, although it is unlikely that a woman will transmit HIV to her baby when breastfeeding it is currently advised not to breastfeed.
Can Hiv Be Passed To An Unborn Baby In Pregnancy Or Through Breastfeeding
Yes, it’s possible for HIV to be passed from a woman to her baby.
This can happen:
- during labour and birth
- through breastfeeding
But if a woman is receiving treatment for HIV during pregnancy and doesn’t breastfeed her baby, it’s possible to greatly reduce the risk of the baby getting HIV.
All pregnant women in the UK are offered a blood test as part of their antenatal screening.
This will test for 4 infectious diseases:
- HIV
- rubella
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What Is The Best Position For Breastfeeding
There are lots of different positions for breastfeeding. Key points are:
- Keep your baby’s head and body in a straight line so that your baby can swallow easily.
- Holding your baby close. Support their neck shoulders and back. The baby should be able to tilt their head back and shouldn’t have to stretch to feed.
- Make sure you are comfortable. Breastfeeding can take some time. Sometimes it helps to use a pillow or cushion for support. Your arms or back may end up aching if you are hunched up for a long period of time.
Hiv Transmission And Breastfeeding: What Do We Know
Breast milk is one of the body fluidsalong with blood, semen , vaginal or rectal fluidsthat transmit HIV. While the risk of transmission through breast milk drops if you are taking HIV drugs and your viral load is undetectable, there may still be some risk. Having an undetectable viral load in blood may not guarantee an undetectable viral load in breast milk. More research is needed into how HIV drugs affect the cells in breast milk, as well as breastfed infants.
A study among more than 2,000 women and their infants in Africa and India, called the PROMISE trial, compared results when either a breastfeeding mother or her infant took HIV drugs. In both parts of the study, HIV transmission rates to babies were found to be very lowless than 1 percent a year after birth. Two infants in this study did acquire HIV from their mothers, though there may be reason to believe the mothers did not have undetectable viral loads at the time of transmission.
In the US and other resource-rich countries, pregnant women are often told that “breast is best,” but women living with HIV are also told that they should not breastfeed. With modern HIV drugs, women’s viral loads may be below detectable levels for a long time. This has many women living with HIV wondering whether the advice not to breastfeed is still true for them.
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Pregnancy Childbirth & Breastfeeding And Hiv
FAST FACTS
- A pregnant woman living with HIV can pass on the virus to her baby during pregnancy, childbirth and through breastfeeding.
- If you are a woman living with HIV, taking antiretroviral treatment correctly during pregnancy and breastfeeding can virtually eliminate the risk of passing on the virus to your baby.
- Attending antenatal appointments means you can get tested for HIV and if needed receive treatment and medical advice to help keep you and your baby healthy.
What Are Other Options For Infant Feeding
Infant Formula
Feeding a baby formula is the safest option from the perspective of HIV, because it is the only way to guarantee absolutely no risk of HIV transmission. Formula is modified cow’s milk. It is available as a powder or liquid . The modifications to the milk make it similar to human breast milk. However, formula does not carry any antibodies and therefore does not provide the protective effects of breast milk. Unlike your own breast milk, formula is not free.
Milk Bank
Women who produce more breast milk than they need for their own baby may give the extra milk to a milk bank. Women with milk to donate go through a screening process and blood tests before donating their milk. The milk bank then gives that milk to babies who for whatever reason cannot be breastfed. In theory this is a good solution for women living with HIV who want to be sure that there is no way they can transmit the virus to their infant. However, since milk banks depend on donated breast milk, they may not always have enough milk to give away. Also, your baby may get milk from different women who pass on different antibodies. This means they may not get as much of a specific antibody as they would if they were always fed by the same woman who passes on only one particular set of antibodies.
Wet Nurse or Cross-Feeding
Flash Heating
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Is Unprotected Anal Intercourse More Of An Hiv Risk Than Vaginal Or Oral Sex
Unprotected anal intercourse does carry a higher risk than most other forms of sexual activity. The lining of the rectum has fewer cells than that of the vagina, and therefore can be damaged more easily, causing bleeding during intercourse. This can then be a route into the bloodstream for infected sexual fluids or blood. There is also a risk to the insertive partner during anal intercourse, though this is lower than the risk to the receptive partner.
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How Do I Know My Baby Is Getting Enough Milk
This is a common concern amongst mothers new to breastfeeding. With bottles of formula you can see exactly how much milk has been drunk. Although you can’t see the amount of breast milk consumed, there are several other ways to determine if your baby is feeding well:
- Watch your baby feeding . You should be able to see sucking, swallowing and full cheeks. When your baby has finished their feed, your breast will feel softer and lighter, especially in the first few weeks.
- If your baby is alert, usually happy when awake and making wet and dirty nappies, they are usually getting enough breast milk. It is common for breast-fed babies to lose a bit of weight initially but, by 2 weeks of age, they should be starting to gain weight.
- Occasionally, a baby that is not putting on weight over time may need topping up with expressed breast milk or formula. Your midwife, health visitor, breastfeeding counsellor or GP can advise you.
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National Surveillance Of Supported Breastfeeding
National data on supported breastfeeding has been collected since 2012 and enhanced surveillance was introduced in August 2018.
The investigators informed the conference that there were 7187 live-birth deliveries to diagnosed HIV-positive women between 2012 and 2019. In 135 cases, planned and/or supported breastfeeding was reported. These mothers had a median age of 35 years, 93% were diagnosed before pregnancy and 83% were born abroad.
Relating to or affecting the gut, stomach or bowel. GI symptoms include diarrhoea, abdominal pain , constipation, gas in the gastrointestinal tract, nausea, vomiting and GI bleeding. Among several possible causes of GI symptoms are infections and antiretroviral medicines.
Enhanced data collection was conducted in 102 cases of women who breastfed. In eleven of these, the partner was unaware that the mother was HIV positive and a fifth of these women had problems attending for monthly viral load monitoring.
Common reasons for wishing to breastfeed included bonding with the infant, health benefits for the child, pressure from family or friends, concerns about disclosure, having previously breastfed after HIV diagnosis, and worries about the cost of formula feed.
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Guidelines were not always followed. Ten women reported mixed-feeding during the first six months and two women continued to breastfeed with mastitis.
Approach To Counseling And Management
If, despite counseling, an individual decides to breastfeed, risk-reduction measures should be taken to reduce the possibility of HIV transmission. Ideally, an individual with HIV who chooses to breastfeed should be adherent to their ARV regimen, should maintain a suppressed viral load during pregnancy, and should be engaged fully in their own care.46 Risk-reduction measures may include the following:
In the unlikely event of HIV transmission via breastfeeding, prompt initiation of a full ARV regimen for the infant is recommended . Drug-resistance testing should be done on the infants viral isolate. If resistance is identified, the ARV regimen can be adjusted appropriately.
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How Often Does A Breast
There are two basic approaches to deciding when your baby should feed, demand-led or scheduled feeding. Breastfeeding on demand means allowing your baby to decide when he wants to feed and how long to feed for. Scheduled feeding means that you decide when your baby should feed, and sometimes how long for, usually because you are trying to establish a routine.
Demand feeding has many advantages:
- It helps establish your breast milk and helps you produce the right amount for your baby, so that your breasts ‘settle down’ and become less prone to engorgement.
- It makes up for the fact that, unlike bottle-feeding, you can’t tell how much milk your baby has taken each time. If they had a smaller feed they may be hungry again sooner.
- It means that your baby can satisfy their hunger when they are hungry, and can increase feed frequency or amount during a growth spurt.
- It also seems to give babies extra benefit in their school performance when they are older .
Breastfeeding By Women With Hiv Infection
If you have HIV, the Ministry of Health recommends you dont breastfeed your children.
You have the right to be fully informed about how to feed your baby.
In developing countries, the nutritional and health benefits of breastfeeding outweigh the risk of transmitting HIV. This is not the case in New Zealand, where there are safe and effective alternatives to breastfeeding.
Research from the developing world shows that women living with HIV can reduce the risk of passing HIV to an infant through breastfeeding by following a regimen of anti-retroviral therapy and exclusively breastfeeding for up to six months. However, there isn’t enough research to show that this completely eliminates the risk of passing HIV on to an infant, so we recommend that women with HIV do not breastfeed.
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Prevention Of Hiv Infection In Women Who Are Breastfeeding
Acquiring HIV while breastfeeding significantly increases the chance of mother-to-child HIV transmission due to the mothers viremia and increased infectivity during acute HIV infection. The NYS AIDS Institutes Perinatal HIV Prevention Committee recommends that a risk reduction plan should be in place for breastfeeding women who are at significant risk for HIV acquisition toreduce the incidence of acute infection and subsequent transmission to their infants. Risk factors include having a new diagnosis of a sexually-transmitted infection, a partner known to be infected with HIV, or using injection drugs. A discussion of HIV pre-exposure prophylaxis , which is a biomedical intervention using antiretroviral medications in non-HIV infected individuals to reduce their risk of acquiring HIV infection, should be included in the plan. Prevention of acute infection in a breastfeeding woman outweighs any theoretical concerns due to toxicity in the infant from TDF/FTC exposure during breastfeeding. Evidence to date suggests that the use of TDF is safe during breastfeeding and that PrEP drug exposure to infants through breastmilk is much lower than fetal antiretroviral drug exposures that occurs in utero in women who are on combination antiretroviral drug therapy.2
How To Feed Your Baby If You Are Hiv Positive
Breast milk, even when treated with drugs to reduce the severity of AIDS or HIV in your body can be passed onto your baby. The safest way to feed your child is by preparing baby formula or bottle feeding your child.
To feed baby formula is considered safe as the formula is usually made with powder and water. This means it is manmade and has no exposure to the disease. To prepare the formula, simply follow the steps mentioned below:
- Sterilize the storage container with boiling water.
- Prepare the formula by adding warm water to the formula feed powder.
- Store the container in the refrigerator and use within a day or two.
If your doctor advises you to breastfeed, then it is recommended that you follow the steps mentioned below:
- Breastfeed your child exclusively for 6 months, and ensure you get treated with ART at least once a week.
- Use heated breast milk or expressed breast milk to reduce the risk of spread of AIDS/HIV.
- Ensure your baby is treated for the entire period you breastfeed.
- Check them regularly.
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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.
Expressing Milk With A Breast Pump
- Follow the instructions on the pump, which will have a suction cup which you place over the nipple. These sometimes come in different sizes.
- Different pumps suit different women, so if you can borrow one first this may be helpful.
- Manual pumps are cheaper but tend to be slower, and your pumping hand can get quite tired.
- You may be able to hire or borrow an electric pump.
- Always make sure that the pump and container are clean and sterilised before you use them.
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Eliminating Hiv Transmission Through Breast Milk From Women Taking Antiretroviral Drugs