Infant Feeding for HIV-Positive Mothers

The World Health Organization (WHO) recommends the implementation of a comprehensive strategic approach for preventing HIV infection among infants and children that includes four elements¹ . This AIDSTAR Prevention Resource page relates to Element Three, and addresses primarily the postnatal period and infant feeding practices.

Many HIV-positive mothers will not transmit HIV to their infants; however there is a risk of mother-to-child transmission (MTCT) during pregnancy, labor and delivery or through breastfeeding. The transmission rate without any intervention is estimated to be thirteen to 30 percent in non-breastfeeding populations. Breastfeeding by an HIV-infected mother is thought to increase the risk by five to twenty percent². The risk of transmission from breastfeeding increases if a mother becomes infected with HIV during the breastfeeding period³ or if she practices mixed feeding. Mixed feeding is defined here as breastfeeding combined with feeding other fluids, solid foods and/or non-human milk, such as infant formula or animal milks.

While formula feeding does avoid the risk of HIV transmission altogether, it carries other serious health risks to the infant such as diarrheal disease, respiratory illness, malnutrition and increased mortality, especially if clean water is not available. The goal of preventing mother-to-child transmission (PMTCT) programs is to not only prevent pediatric HIV, but to assure “HIV–free survival”, that is, to ensure that infants not born with HIV survive and remain healthy.

While considerable progress has been made in reducing MTCT during pregnancy and labor/delivery, avoiding transmission during breastfeeding has remained challenging. The risk of HIV transmission through breastfeeding can be significantly reduced by practicing exclusive breastfeeding (an infant receives only breast milk and no other liquids or solids, not even water, with the exception of drops or syrups consisting of vitamins, mineral supplements or medicines). Further reduction of HIV transmission risk is likely to be achieved if mothers and/or infants receive ARV drugs throughout the breastfeeding period. Several protocols for extended ARV prophylaxis are currently under study. In late 2009, WHO released new guidelines; among them was the recommendation that breastfeeding HIV-positive mothers or their infants take ARVs to reduce vertical transmission.⁴