Scaling Up Viral Load Monitoring
Breastfeeding women are a priority population for repeated plasma viral load measurements. However, in many Global Plan priority countries viral load monitoring scale-up is limited because of logistical challenges relating to plasma specimen collection. This requires EDTA tubes, which are often unavailable, can break in transit, and require storage, a cold chain, timely centrifugation, and transportation to central laboratories.39
Some countries have used dried blood spot or plasma separation cards to scale up viral load testing however, dried blood spot viral load testing cannot reliably measure viral loads < 1000 copies/mL.39 Furthermore, the median time between sample collection and availability of results can be as long as 72 days.4041 Investing in mobile health technologies for use by clinicians and patients may improve turnaround times and prompt action for high viral load measurements. Plasma separation cards have a slightly lower limit of detection ),41 are cost neutral,39 and are easier to use.
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.
Why Milk Is Yellow
Complete answer: Cow milk contains a coloring pigment Beta-carotene which is found in the grass where the cows graze on. It is a fat-soluble pigment responsible for the yellow color of milk and milk products like cream, butter, ghee, etc. -Carotene is an antioxidant that serves various immune regulatory properties.
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Is It Possible For Adults To Get Hiv From Breast Milk
breast milk does not seem to transmit HIV, which isnt sure. It is believed that if a mother has recently been infected with primary infection the likelihood of the infection being present is higher as well. According to the results of some studies, low viraemias is believed to influence the incidence of breast milk transmission of HIV.
What Is The Risk Of Passing On Hiv To Your Baby During Feeding
If you use formula feeding, the risk of HIV transmission is zero. In the UK and other countries where women can formula feed safely, you are advised only to feed your baby with formula milk from birth.
If you have been on treatment for a while and it is working well, the risk during breastfeeding is low. It does however depend on your viral load, your own state of health, your babys health and how long you breastfeed the child. Breastfeeding is only recommended where formula feeding is not considered safe, for example in low income countries.
Taking antiretroviral treatment substantially lowers the risk of passing on HIV through breast milk. Some estimates put the risk of transmission after birth at 1% if a woman breastfeeds for six months, and at almost 3% if she breastfeeds for one year.In most of the studies on which these figures are based however, not all the women were taking treatment for the whole time they were breastfeeding. The more recent PROMISE study, in which mothers received HIV treatment for the entire time of breastfeeding, estimated the risk of transmission at 0.3% after six months of breastfeeding and 0.6% after 12 months. Higher viral loads were associated with a greater risk of transmission. This study found two cases of babies acquiring HIV despite their mothers having an undetectable viral load at the time.
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Telling Health Professionals About Your Hiv Status
It is important to tell your doctor, obstetrician or midwife about your HIV status as early as you can .
Telling your health team, helps to talk through any concerns you may have and ensure you receive treatment before that suits your needs, and is safe throughout pregnancy and after your baby is born.
Also, if your medical team knows about your HIV status, they can take steps to minimise the risk of accidental transmission during any medical procedures.
Cold Breastmilk May Upset Your Babys Stomach
There is no scientific evidence to support this claim but many mothers complain that when they have fed their babies cold breastmilk, they end up with an upset stomach.
So even without the science to back it up, we still need to acknowledge that this may happen. If it does, I would go back to feeding warm breastmilk to my baby.
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Is It Safe For A Mother Infected With Hiv To Breastfeed Her Infant
No. The best way to prevent transmission of HIV to an infant through breast milk is to not breastfeed. In the United States, where mothers have access to clean water and affordable replacement feeding , CDC and the American Academy of Pediatricsexternal icon recommend that HIV-infected mothers completely avoid breastfeeding their infants, regardless of ART and maternal viral load. Healthcare providers should be aware that some mothers with HIV may experience social or cultural pressure to breastfeed. These mothers may need ongoing feeding guidance and/or emotional support.
In resource-limited settings, such as some parts of Africa, the World Health Organization recommends that HIV-infected mothers breastfeed exclusively for the first 6 months of life and continue breastfeeding for at least 12 months, with the addition of complementary foods. These mothers should be given ART to reduce the risk of transmission through breastfeeding.
Special Supplemental Nutrition Program For Women Infants And Children
Income-eligible women who qualify for WIC should be referred to their local WIC agency. WIC provides nutrition advice, nutritious foods for both mother and baby including formula, breastfeeding support and referrals to other services.
WIC provides lactation support by staff with expertise in breastfeeding education and lactation counseling. WIC staff conduct breast pump assessments to ensure that participants have the appropriate pump to meet their needs, and provide instructions in the use of a breast pump, and the care and storage of pumped breastmilk. WIC can also provide breast pumps to participating women.
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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.
Breastfeeding And Strategies To Reduce Risk Of Hiv Transmission
Both the evidence regarding the risk of HIV transmission via breastfeeding and the strategies to reduce this type of transmission come from studies conducted in low- and middle-income countries, where rates of infant mortality are high and many families do not have access to safe water and affordable formula. Without maternal ART and infant ARV prophylaxis, the risk of a breastfeeding infants acquiring HIV from a mother with HIV is 15% to 20% over 2 years.19,20
Studies have shown that maternal ART throughout pregnancy and breastfeeding as well as infant ARV prophylaxis during breastfeeding can reduce, but not eliminate, the risk of breast milkassociated HIV transmission.21-25 However, most of these studies provided ARV drugs to women or their infants only through 6 months postpartum and collected limited data on maternal plasma HIV viral load during breastfeeding.
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Maternal Conditions Where Breastfeeding Is Not Advisable But A Mother’s Own Expressed Breastmilk Can Be Provided
Maternal conditions where breastfeeding is not advisable include:
- Having untreated, active tuberculosis. The mothers expressed breastmilk can be fed to the infant because there is no concern about the spread of tuberculosis through the milk. Breastfeeding may resume after a minimum of 2 weeks of treatment when the mother is determined to no longer be infectious.1
- Varicella. If the mother develops varicella-zoster infection 5 days before through 2 days after delivery, she should be separated from her infant. The infant would be considered exposed to, and at high risk for acquiring, chickenpox, and in need of prophylaxis with varicella immune globulin. The mother can feed the infant her expressed breastmilk in the interim .1
- Having active herpetic lesions on breast. Breastfeeding should be avoided until all lesions are healed if unilateral lesions are present, breastfeeding may continue on the unaffected breast. Lesions should be covered to prevent exposure to the infant. The mother can feed expressed breast milk to her infant as there is no concern of herpes transmission through the milk.1
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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Misadministration Of Breast Milk
Misadministration of breast milk, also known as misappropriation, breast milk exposure, and accidental ingestion of breast milk, and other terms, is a medical-legal issue when it occurs in a hospital. This scenario occurs when one infant receives breast milk from another mother by mistake. This occurrence can be very distressing to the families and medical staff involved. The actual risk for transmission of an infectious agent to an infant via a single ingestion of expressed breast milk from another mother is exceedingly low. In this scenario, the CDC recommends treating this as an accidental exposure to a body fluid, which could be infectious. Bacterial, fungal, or parasitic infection from the one exposure is highly unlikely. The concern is about viral pathogens, known to be blood-borne pathogens, which have been identified in breast milk and include but are not limited to hepatitis B virus , hepatitis C virus , cytomegalovirus , West Nile virus, human T-cell lymphotropic virus , and HIV.
Additional important components of the hospital-based protocols for managing accidental expressed breast milk exposure include ongoing psychosocial support for the families and staff, documentation of medical discussions with the families, investigative steps, consents and interventions, and the demonstration of ongoing infection control efforts to prevent additional events of misadministration of breast milk.
Reducing Hiv Transmission During Labour
Ways to reduce HIV transmission during birth include:
- Avoiding procedures in labour that may scratch or cut the babys skin, wherever possible .
- Giving antiretroviral medications to the newborn for around 4 weeks after birth.
Caesarean delivery is recommended if a woman:
- Has a detectable viral load, .
- Is not taking antiretroviral treatment.
- Experiences obstetric delivery complications .
- Has other medical illness complications.
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Can Illness Be Passed Through Breast Milk
Breastfeeding should continue if you have a cold, flu, fever, diarrhea, or vomiting, or mastitis. It is unlikely that your baby will catch the illness from breast milk in fact, she will be protected from the same bug by antibodies in her milk. Breastfeeding while sick is a good idea, not only because it is safe, but also because it is healthy.
The Hiv Virus Is Spread In Breast Milk Only
The transmission of HIV can occur from the mother to her son or daughter via breast milk in which case the HIV-positive baby consumes the viral milk. Babies feeding with mixed foods, which may consist of food provided by commercial suppliers, but no breast milk, have an increased risk of exposure to this phenomenon.
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Fear Of Vertical Hiv Transmission
Even though healthcare providers counselled their clients on the benefits of breastfeeding and discussed risks so women could weigh HIV transmission risk to the benefits of breastfeeding, for women who chose to formula feed, any element of HIV transmission risk outweighed the benefits of breastfeeding:
They are being counselled to breastfeed, but also warned about the potential dangers of mixed feeding, transmission, and because some of the mixed feeding may be out of their control, out of an abundance of caution they choose formula feeding. -HIV Counsellor
Most women expressed a fear of transmission of HIV to their infants. Among all women who had opted for formula feeding, the decision to do so was driven by fear of HIV transmission to the baby:
I didnt want any chance for them to get HIV. I felt that they said if you are positive and take your medication properly, then you can have a negative baby. I decided that I dont want any chance. Woman living with HIV, age 37, formula feeding
Even women who breastfed uniformly expressed concerns around transmission of HIV to their baby, and how this generated uncertainty around their feeding choice:
As you know your status you would want to breastfeed but sometimes you would think that if your baby would end up being like that, if he becomes positive I will always blame myself. You will do whatever you can but you will not be happy, you will just breastfeed. Woman living with HIV, age 32, breastfeeding
Could Hiv Be Transmitted Through Breast Milk
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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 .
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
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Cold Breastmilk May Give Your Baby Gas
Again, there is no scientific evidence or research to support this. But every baby has their own individual digestive system. Some things will upset one baby whereas another will have no problems with it at all.
If your baby is one that suffers from gas after taking cold breastmilk, you would be best to go back to feeding them warm breastmilk.
Getting Pregnant When You Are Hiv
If you want to conceive, are an HIV-positive woman with an HIV-negative male partner, you can choose artificial insemination. You can do this at home using your partners semen, rather than having unprotected sex.
To improve your chances of becoming pregnant through artificial insemination it is best to do it at the most fertile time in your menstrual cycle.
Learning about fertility awareness will help you to know when you are most likely to conceive.
Speak to your GP, HIV doctor, sexual health nurse, or fertility specialist.
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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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