Antiretroviral drugs and breastfeeding
Q.5 How can the 2010 Guidelines state that 12 months of breastfeeding is safe when the research only reported results until 6 months?
There are three main justifications for extending the recommendations beyond the period of breastfeeding with ARVs reported in the medical literature.
- the evidence from the published reports indicates that the protection from ARVs continues as long as the mother or infant continues to take them. There is no reduction in protection over time while the mother or infant takes the ARVs, and, as soon as either the mother or infant stops taking ARVs the risk of HIV transmission returns. This is called a linear relationship between taking the ARVs and the infant being protected from HIV infection through breastfeeding and means that ARVs are likely to protect infants for as long as they are given;
- there is no evidence to show that side effects due to ARVs increase with longer periods of ARV use. Most side effects occur early, soon after first exposure to the ARVs. So, whether a mother or infant takes ARVs for a shorter or longer period of time, the evidence does not show any increase in side effects.
- continuing breastfeeding with ARV protection to 12 months is likely to improve HIV-free survival of the infant. Even after 6 months (the time during which the longest study gave ARVs for protection against breastfeeding transmission), there are still risks of serious diarrhoea, pneumonia, malnutrition and death associated with stopping breastfeeding early.