HIV-positive mothers can breastfeed if they are on treatment and the virus is undetectable, group of pediatricians says

CNN
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Every time LaTonya looks at framed photos of her breastfeeding her baby for the first time, she swells with emotion.

As a mother living with HIV in Colorado, it was a moment she wanted to commemorate.

“That’s how important it was to me to be able to breastfeed,” LaTonya said of the photos. “So I wanted to make sure we had it forever.”

For the first time, the American Academy of Pediatrics has changed its position to say that people living with HIV, the human immunodeficiency virus, can breastfeed their infants with “very low” risk if they follow certain guidelines with support from their medical team.

Avoiding breastfeeding is the only option with zero risk of HIV transmission, but in the future, pediatricians should offer support and counseling to women who wish to breastfeed, who are receiving antiretroviral treatment, called ART, as prescribed and who maintain an undetectable amount of breastfeeding. virus in the body, according to a new AAP clinical report published Monday in the journal Pediatrics.

Previously, the academy recommended that HIV-positive mothers in the United States not breastfeed their infants, regardless of viral load and use of antiretroviral therapy.

Recommendations against breastfeeding for HIV-positive people date from around 1985, when the U.S. Centers for Disease Control and Prevention recommended that women infected with HIV avoid breastfeeding.

“The AAP recommends that for people living with HIV in the United States, replacement feeding (with formula or certified breast milk from a banked donor) is the only option that is 100% safe. % to prevent postnatal transmission of HIV”, the new the report said. “However, pediatric health professionals should be prepared to provide infant feeding counseling and a family-centered, culturally appropriate risk reduction approach to HIV-positive individuals on ART with sustained viral suppression who wish to breastfeed . »

HIV is a virus that attacks the body’s immune system and, if left untreated, can lead to acquired immune deficiency syndrome or AIDS.

LaTonya has been living with HIV for about 20 years, she said, but as soon as she gave birth to her son, she knew she wanted to breastfeed because of the health benefits of breastfeeding for infants. , particularly because it is associated with a lower risk of asthma, obesity, type 1 diabetes and sudden infant death syndrome.

“Being a mom is absolutely amazing. I wouldn’t trade it for anything,” LaTonya said, adding that every parent wants to give their child “the best chance” to be the best person they can be.

“I feel like breastfeeding was a step toward me being able to provide that for him,” she said of her son.

After speaking with her doctors about her decision, they came up with a plan for her to breastfeed since her viral load is undetectable and she is taking antiretroviral medications.

They discussed “constant viral load monitoring” to make sure there was no spike in his viral load. and that “full compliance with treatment was essential,” LaTonya said. CNN is not publishing his full name to protect his medical confidentiality.

“I think it’s critical that people understand the science behind this,” she said. “If you are undetectable, you cannot pass it on to your partner. It is essential that people understand this and that if you follow your treatment, it will not be passed to your child through breast milk. And so, why deprive your child of… this advantage?

Although HIV can be transmitted to infants through breastfeeding, research has shown that the use of antiretroviral drugs can significantly reduce the risk of HIV transmission, and these medications are safe during breastfeeding.

In the absence of the mother on ART or the infant on preventive antiretroviral drugs, the risk of HIV transmission through breast milk appears to be highest during the baby’s first four to six weeks of life, falling between 5 and 6 %, according to the AAP. report.

But the risk is “estimated to be less than 1%” if the mother is taking antiretroviral drugs and the virus is suppressed in her body, meaning there is no detectable viral load, the report said.

“What is new is that the AAP explicitly states for the first time that HIV-positive pregnant women on treatment and undetectable can be supported to breastfeed,” said Dr. Lisa Abuogi, lead author of the report and a Colorado pediatrician. who works with HIV-positive people during pregnancy.

“It has been a long evolution and people living with HIV have been involved in advocating for this change,” Abuogi said. “Some women feel ashamed or distressed or feel like they are not fulfilling their role as mothers if they cannot breastfeed, and others are really worried that this will reveal their HIV status at the breast. from their community – if breastfeeding is the norm and you have to explain why you don’t do it.

It is estimated that approximately 5,000 people with HIV give birth each year in the United States.

“So having the opportunity to offer women a choice, like all women, and support their decision, it’s really empowering,” Abuogi said. “People living with HIV should have the same infant feeding options as everyone else, and we are working hard to make this decision safe for women. »

Last year, an advisory committee to the U.S. Department of Health and Human Services made similar updates to its infant feeding recommendations, saying that “people with HIV who are on ART with an undetectable viral load and supported and who choose to breastfeed should be supported.” in this decision.

The AAP’s new position now aligns with the HHS panel’s updated recommendations, said Dr. Rana Chakraborty, a pediatric infectious disease specialist and researcher at the Mayo Clinic in Minnesota who is a member of the HHS panel on HIV treatment during pregnancy and prevention. of perinatal transmission.

“It’s something that’s been under discussion for a few years now. It started with the Department of Health and Human Services panel, and I think the authors of that AAP report summarized the current national guidelines in the United States very well,” said Chakraborty, who did not was not involved in the new AAP report.

“A number of investigators, many in the United States working in relatively resource-limited settings, have already been able to demonstrate that breastfeeding can be undertaken safely if the mother is on antiretroviral therapy and maintains an HIV viral load undetectable – in other words, the amount of virus in a drop of blood must be less than 50 copies per milliliter,” he said. “But breastfeeding is also feasible. during maternal HIV infection requires support from a multidisciplinary team of providers to ensure it can be practiced safely for both mother and baby.

The AAP recommendations indicate that there is now consensus among major medical groups that mothers living with HIV can be supported and counseled to breastfeed their babies safely, said Dr. Elaine Abrams, professor of epidemiology and pediatrics at Columbia University Medical Center in New York. , who treated people with HIV during pregnancy and after delivery, but was not involved in the new AAP report.

“All the organizations that provide guidelines to clinicians now say the same thing. We see consensus, and that consensus also puts the mother at the center of the conversation and decision-making,” she said.

“It’s no longer about telling her what to do, but rather understanding what she wants to do, providing her with evidence and information, and then supporting her in her decision,” Abrams added. “Previously, that wasn’t necessarily the case.”

In the early 2000s, studies showed that infants born to HIV-positive women in low-income countries had increased risks of illness and death when given formula – and this was associated with mothers not They had no drinking water to mix with. with the formula, according to the new AAP report. This prompted the World Health Organization to recommend that people with HIV breastfeed their babies in places without clean water and accessible infant formula.

As more HIV-positive mothers breastfed, more studies found that when the mother took ART or the infant received antiretrovirals for prevention,…