The main changes
Q.1 What is the difference between the 2007 Guidelines on HIV and infant feeding and the 2010 Guidelines?
The 2010 Guidelines are consistent with the former Guidelines in many respects. There are, however, two significant revisions in the 2010 Guidelines:
The 2010 Guidelines state that national health authorities should promote a single infant feeding practice for HIV-infected mothers as the standard of care. While information about other practices should be made available to HIV-infected mothers, health services would principally recommend one infant feeding approach, either breastfeeding with antiretroviral drugs (ARVs) or replacement feeding, for all HIV-infected mothers. The 2007 Guidelines suggested that health workers should individually counsel all mothers known to be HIV-infected, who would then decide the most appropriate infant feeding strategy for their circumstances.
The 2010 Guidelines now state
National health authorities, or even subnational authorities where appropriate, should decide whether health services will principally counsel and support mothers known to be HIV-infected to either breastfeed and receive ARV interventions (for themselves or for their infants), or, avoid all breastfeeding, as the strategy that will most likely give infants the greatest chance of remaining HIV uninfected and alive.
Rationale for the new Guidelines
The 2010 Guidelines state that, in view of the effectiveness of ARV interventions, continued breastfeeding by HIV-infected mothers until the infant is 12 months of age capitalizes on the maximum benefit of breastfeeding to improve the infant's chances of survival while reducing the risk of HIV transmission. The 2007 Guidelines, which were formulated in the absence of ARV interventions, suggested that exclusive breastfeeding should be practiced until the infant reached 6 months of age unless specific conditions for replacement feeding (referred to as AFASS) were in place. Thereafter, breastfeeding should continue with the addition of complementary foods.
In settings where national authorities promote breastfeeding and ARVs
Mothers known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status) should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary foods thereafter, and continue breastfeeding for the first 12 months of life. Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided.
- How can the 2010 recommendations state that 12 months of breastfeeding is safe when the research only reported results until 6 months? (Q.5)
- What are the differences now between infant feeding recommendations for HIV-infected mothers versus HIV-uninfected mothers? (Q.20)
- The recommendations say that mothers should breastfeed for 12 months. Can a national authority recommend longer than this? (Q.24)