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.
Inconsistent Messaging Delivered By Healthcare Providers
Although providers overall were supportive of breastfeeding over formula feeding when mothers were virally suppressed, many providers acknowledged that women living with HIV may receive inconsistent messages related to infant feeding:
I think breastfeeding is like falling pregnant, there are health care workers who would encourage an HIV positive woman to fall pregnant and there are those who wont encourage HIV mothers to breastfeed because they are afraid that they will infect their babies. Nurse
Many providers also expressed that inconsistent messages regarding infant feeding for mothers living with HIV could be the result of frequently changing guidelines:
If maybe we could sing the same song and all that, then people will be having the same information about that . The disadvantage, again is that then government will change it . Lay Counsellor
How Is Hiv Spread From Person To Person
HIV can only be spread through specific activities. In the United States, the most common ways are:
- Having vaginal or anal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV. Anal sex is riskier than vaginal sex.
- Sharing injection drug equipment , such as needles, with someone who has HIV.
Less common ways are:
- From mother to child during pregnancy, birth, or breastfeeding. However, the use of HIV medicines and other strategies have helped lower the risk of mother-to-child transmission of HIV to 1% or less in the United States.
- Getting stuck with an HIV-contaminated needle or other sharp object. This is a risk mainly for health care workers. The risk is very low.
HIV is spread only in extremely rare cases by:
- Having oral sex. But in general, the chance that an HIV-negative person will get HIV from oral sex with an HIV-positive partner is extremely low.
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Infant Feeding Advice For Women With Hiv Living In The Uk
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.
The most recent guidelines from the British HIV Association state that in the UK and other high-income settings, the safest way to feed infants born to women with HIV is with formula milk, as this means there is zero risk of ongoing HIV exposure after birth. BHIVA therefore recommends that women living with HIV feed their babies with formula.
BHIVA also recommends that women who need it should be given free formula milk, although in fact it is not available in all areas. Ask your healthcare team or support organisation if you have difficulty meeting the cost of formula and the equipment needed, as financial and other help may be available.
When mothers do not breastfeed their breasts still produce milk, which can be very uncomfortable and may cause distress. The recommendations therefore state that women living with HIV who do not breastfeed should be offered medication within 24 hours of delivery that suppresses milk production to ease the discomfort.
Feeding time can still be an occasion for bonding with your baby. Holding your baby skin to skin, with no clothes between you, while you are feeding him or her, can help you feel close to your baby and is recommended, particularly in the early days.
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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What Is Formula Feeding
For all babies, the only recommended alternative to breastfeeding for the first six months of their life is infant formula, also known as formula milk, given by bottle. Babies should not be offered solid food until they are six months old.
Infant formula is made from cows milk that has been treated to make it more suitable for babies. It usually comes in the form of a dry powder that has to be made up with water that has been boiled and cooled . Ready-to-feed liquid formula is also available but is more expensive and once opened must be used quickly.
pneumonia
Any lung infection that causes inflammation. The infecting organism may be bacteria , a virus , a fungus or something else. The disease is sometimes characterised by where the infection was acquired: in the community, in hospital or in a nursing home.
Good hygiene is very important when making up a formula feed because a baby’s immune system is not as strong as an adults. Diarrhoea and vomiting caused by bacteria are dangerous for newborns.
To avoid infection, there are a few things you must do:
Bottled water is not recommended for making up feeds, as it’s not sterile and may contain too much salt or sulphate. However, you may need to use bottled water to make up a feed if drinking the local tap water is not recommended. If you have to use bottled water to make up a feed:
- Check the label to make sure the water contains:
How Is Hiv Transmitted
The person-to-person spread of HIV is called HIV transmission. People can get or transmit HIV only through specific activities, such as through sex or injection drug use. HIV can be transmitted only in certain body fluids from a person who has HIV:
- Blood
- Vaginal fluids
- Breast milk
HIV transmission is only possible if these fluids come in contact with a mucous membrane or damaged tissue or are directly injected into the bloodstream . Mucous membranes are found inside the rectum, the vagina, the opening of the penis, and the mouth.
In the United States, HIV is spread mainly by:
- Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV
- Sharing injection drug equipment , such as needles, with someone who has HIV
HIV can also spread from a woman with HIV to her child during pregnancy, childbirth , or breastfeeding. This is called mother-to-child transmission of HIV.
You can’t get HIV from casual contact with a person who has HIV, such as a handshake, a hug, or a closed-mouth kiss. And you can’t get HIV from contact with objects such as toilet seats, doorknobs, or dishes used by a person who has HIV. Use the ClinicalInfo You Can Safely ShareWith Someone With HIV infographic to spread this message.
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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.
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.
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Sharing Injection Drug Equipment
Sharing needles for injecting drugs most efficiently transmits HIV. This is because used needles and syringes can still contain blood, which can carry the virus.
An older study found that HIV can survive up to 42 days in syringes, depending on the temperature.
HIV isnt the only virus that can be transmitted by sharing injection drug equipment. The viruses that cause hepatitis B and hepatitis C can be transmitted in this way as well.
There are also some less common ways that HIV can be transmitted. Lets take a look at some of them below.
Get Tested For Hiv As Soon As Possible To Know Your Status
- If you have HIV, the sooner you start treatment the betterfor your health and your babys health and to prevent transmitting HIV to your partner.
- If you dont have HIV, but you or your partner engage in behaviors that put you at risk for HIV, get tested again in your third trimester.
- You should also encourage your partner to get tested for HIV.
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Update On Hiv And Breastfeeding
Pamela Morrison, IBCLC, West Sussex, England
La Leche League Leaders occasionally receive requests for information about whether mothers who have tested positive for the Human Immunodeficiency Virus can breastfeed their babies.
Although the discovery that the virus can be passed from mothers to babies during breastfeeding was made in 1985, the original international advice from the World Health Organization was that breastfeeding should continue, since the risk of death from acquisition of the virus through mothers milk was less than the risk to babies when breastfeeding was withheld. It was not until 1997 that this recommendation changed to suggest that when formula feeding could be made acceptable, affordable, feasible, sustainable and safe, then there was less risk to babies when breastfeeding was withheld.
In spite of this guidance, it is often believed that a diagnosis of HIV precludes breastfeeding. It needs to be acknowledged that in the era of effective antiretroviral treatment, fears of transmission through breastfeeding are often exaggerated, while the risks of formula-feeding are down played.
In 2013 the American Academy of Pediatrics issued recommendations outlining that support should be given to HIV+ mothers who wanted to breastfeed. While formula-feeding is described as the initial option, later in the document, specific strategies for support and care of breastfeeding mothers and their babies are clearly outlined.
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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Contaminated Blood Transfusions And Organ/tissue Transplants
- receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. This risk is extremely small because most countries test blood products for HIV first.
If adequate safety practices are not in place, healthcare workers can also be at risk of HIV from cuts made by a needle or sharp object with infected blood on it. However, the risk of occupational exposure, is very low in most countries.
If you think you have been exposed to HIV, the only way to find out if you have HIV is to have an HIV test.
Getting Pregnant When Both Parents Have Hiv
Seroconcordant couples , can have an HIV-negative child. If both partners are on treatment, the risk of either partner transmitting HIV to their baby is almost zero.
If you are a seroconcordant couple and you are thinking of becoming pregnant it is important to speak with an obstetrician and an HIV specialist to minimise the risk of transmitting HIV to your baby.
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Reducing The Risk Of Passing Hiv To Your Baby
If you have HIV, you can reduce the risk of passing it to your baby by:
- taking antiretroviral drugs during pregnancy, even if you don’t need HIV treatment for your own health
- considering the choice between a caesarean or vaginal delivery with your doctor
- bottle feeding your baby, rather than breastfeeding
- your doctor prescribing your baby antiretroviral drugs for up to 4 weeks after they have been born
Do not breastfeed your baby if you have HIV, as the virus can be transmitted through breast milk.
Things You Need To Know About Breastfeeding And Hiv
Globally, over 36 million people are living with HIV and almost 2 million of these cases are children under the age of 15. Although far too many people are living with HIV globally, there has been remarkable progress in reducing new infections particularly in preventing mother-to-child transmission. Between 2010 and 2017, the number of new infections among children under 5 declined by 35 percent and AIDS-related deaths among young children declined by nearly half.
Despite this noteworthy progress, there are still misconceptions about a womans ability to breastfeed if she is HIV positive. Mothers who are on consistent antiretroviral treatment throughout the breastfeeding period have an extremely low risk of transmitting HIV to their babies. Supporting an HIV-positive womans ability to breastfeed through ARV treatment and lactation counseling gives children the lifesaving benefits of breastmilk. It also dually improves the womans own health by conferring the maternal health benefits of breastfeeding and improving her health through ARV treatment. By strengthening support for HIV treatment and breastfeeding, we can improve survival and health for both mothers and children.
Note: The facts below are based on the recently published Breastfeeding and HIV Advocacy Brief. For more resources, check out the Global Breastfeeding Collective, led by UNICEF and WHO.
Here are 5 things you need to know about breastfeeding and HIV:
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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.