Group of US pediatricians reverses decades-old ban on breastfeeding for HIV-positive people

People with HIV can breastfeed their babies, as long as they take medications that effectively suppress the virus that causes AIDS, a group of leading U.S. pediatricians said Monday, in a sweeping policy shift.

The new report from the American Academy of Pediatrics reverses recommendations that have been in place since the start of the HIV epidemic in the 1980s.

It recognizes that commonly prescribed medications can reduce the risk of HIV transmission through breast milk to less than 1 percent, said Dr. Lisa Abuogi, a pediatric HIV expert at the University of Colorado and lead author of the report.

“The medications are so effective now and the benefits for mom and baby are so great that we are at a point where it is important to engage in shared decision-making,” Abuogi said.

The medications, known as antiretroviral therapy, do not eliminate all risk of transmitting HIV through breast milk. Avoiding breastfeeding is the only sure way to prevent the spread of the virus, Abuogi said.

Additionally, parents should exclusively breastfeed their baby for the first six months, as research shows that switching from breast milk to formula can disrupt the infant’s gut and increase the risk of HIV infection.

About 5,000 people with HIV give birth each year in the United States. Almost all take medications to suppress the virus at very low levels, Abuogi said, although viral levels can rebound if they don’t take them.

Before drugs became widely available a decade ago, about 30 percent of HIV infections passed from mothers to babies occurred during breastfeeding, said Dr. Lynne Mofenson, an advisor to the Elizabeth Glaser Pediatric AIDS Foundation. In the early 1990s, approximately 2,000 infections occurred in American infants each year. Today, there are fewer than 30.

The AAP policy comes more than a year after the National Institutes of Health and the Centers for Disease Control and Prevention reversed long-standing recommendations against breastfeeding among HIV-positive people. These guidelines stated that people with consistent viral suppression should be counseled about their options. It also emphasizes that health care providers should not alert child welfare agencies if an HIV-positive parent seeks to breastfeed.

The goal is to listen to patients “and not blame or shame them,” said Dr. Lynn Yee, a professor of obstetrics and gynecology at Northwestern University who helped write the guidelines. NIH.

Breastfeeding provides ideal nutrition to babies and protects them against diseases and conditions such as obesity and type 2 diabetes, research shows. Breastfeeding also reduces the risk of breast and ovarian cancer, diabetes and high blood pressure.

Since 2010, the World Health Organization has recommended that HIV-positive women in developing countries breastfeed their infants and have access to antiretroviral treatment. The guidelines assessed the risk of infants contracting HIV through breastfeeding and the risk of babies dying from malnutrition, diarrhea and pneumonia in places where safe substitutes for breast milk are not available.

In developed countries, however, experts have recommended against breastfeeding because the wide availability of clean water, infant formula and breast milk could eliminate the risk of HIV transmission, Yee said.

This frustrated HIV-positive people who were flatly denied the opportunity to breastfeed.

Ci Ci Covin, 36, of Philadelphia, said she was diagnosed with HIV when she was 20 and was not allowed to breastfeed her first child, Zion, now 13 years.

“I didn’t understand why my sister who lives in a place like Kenya, who looks like me with the same brown skin color, had the option to breastfeed and how my choice was a categorical no,” she said.

Not being able to breastfeed her son sent Covin into a spiral of postpartum depression, she said. When she became pregnant with her daughter Zuri, now 2, her healthcare team helped her breastfeed for seven months. Covin took her prescriptions as directed and also gave the baby medication to prevent infection.

“Breast milk has everything my baby would need,” Covin said. “It’s a beautiful thing.”

Abuogi said the AAP report provides crucial guidance to pediatricians, nurses and lactation specialists who work directly with children and families.

Some providers were already helping people being treated for HIV breastfeed their babies, despite previous recommendations. The new guidelines should expand this practice, hopefully quickly, Abuogi said.

“This is a unique situation because it’s not just doctors and providers that are changing,” Abuogi said. “Our patients are asking for it too. »

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Education Media Group. The AP is solely responsible for all content.