7.1.3 ARV drugs and duration of breastfeeding

Consolidated ARV guidelines, June 2013

Clinical considerations for supporting mothers with HIV to breastfeed

Key clinical and implementation considerations for using ARV drugs during breastfeeding include:

  • postnatal prophylaxis for infants remains critical: infants of mothers who are receiving ART and are breastfeeding should receive six weeks of infant prophylaxis with daily NVP (section 7.2.2 First-line ART for pregnant and breastfeeding women and ARV drugs for their infants);
  • specific interventions (such as integrated follow-up with immunization and other wellchild services) should be considered to improve postpartum follow-up of mother–infant pairs, which is often weak in most programmes; and
  • communicating clearly and effectively with the community and users the value of breastfeeding with ARV drugs and local considerations regarding the duration of breastfeeding.

In addition, the Guidelines Development Group emphasized the need to support enhanced monitoring for potential toxicities from prolonged exposure to ARV drugs (such as sentinel site monitoring of infant cohorts during the first two years of life), for the next three to five years, and to continue monitoring as new drugs are introduced, to assess the effects of ARVs especially on neurodevelopmental outcomes and renal and bone health.