Updates on HIV and infant feeding
WHO guidelines on HIV and Infant Feeding in 2010 for the first time recommended the use of antiretroviral drugs to prevent postnatal transmission of HIV through breastfeeding. This resulted in a major change from an individualised counselling approach toward a public health approach regarding how maternal and child health services should routinely promote and support infant feeding practices among mothers living with HIV.
Since then, almost all countries prioritised in the UNAIDS ‘Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive’ have adopted the approach of promoting and supporting breastfeeding and the provision of lifelong antiretroviral treatment as the strategy to optimise HIV-free survival among HIV-exposed, uninfected infants and children.
Since 2010, a number of questions have arisen following implementation of the recommendations at country level. These questions were identified during a guideline scoping meeting convened at UNICEF in New York, November 2014. The following questions were prioritised and are addressed in the updated guideline.
- For how long should a mother living with HIV breastfeed if she is receiving ART and there is no evidence of clinical, immune or viral failure?
- Can facility- and community-based interventions improve the quality of infant feeding practices among mothers living with HIV?
- If a mother living with HIV does not exclusively breastfeed, is mixed feeding with ART better than no breastfeeding at all
- If a mother living with HIV plans to return to work or school, is a shorter duration of planned breastfeeding with ART better than no breastfeeding at all?
The 2016 guidelines provide two Recommendations and two Guiding Practice Statements addressing these four questions. In addition, the guidelines comment on the implications for:
- routine monitoring and evaluation, and
- conflict and emergency settings.
Annex 1. Systematic reviews including GRADE tables related to the duration of breastfeeding by mothers living with HIV
HIV-free survival at 12–24 months in breastfed infants of HIV-positive women on ART: a systematic review. Commissioned for the guideline review
Postnatal HIV transmission rates at age 6 and 12 months in infants of HIV-positive women on ART initiating breastfeeding: a systematic review. Commissioned for the guideline review
Modelling the impact of maternal ARV use and infant mortality. Commissioned for the guideline review
Annex 2. Systematic reviews including GRADE tables related to interventions to improve infant feeding practices by mothers living with HIV
Effectiveness of interventions to promote exclusive breastfeeding in women living with HIV that are on antiretroviral therapy living in areas that promote exclusive breastfeeding due to limited resources for safe replacement feeding