LaTonya gets emotional seeing pictures of herself nursing her child for the first time. For one Coloradoan living with HIV, this was a very important time. “To me, breastfeeding was so important,” LaTonya said. “I wanted to hold onto that memory for ever.”
The American Academy of Pediatrics (AAP) has made the ground-breaking decision that, provided they adhere to certain recommendations and have assistance from their medical team, moms living with HIV can breastfeed their children with a “very low” risk of transmission. This is a significant departure from the earlier advice, which forbidden nursing irrespective of the mother’s viral load or state of treatment.
New Recommendations for HIV-Infected Nursing Mothers
AAP and U.S. Centers for Disease Control and Prevention (CDC) previously advised moms living with HIV to stop nursing in order to reduce the chance of passing the virus to their unborn children. This direction was first issued in 1985. But a recent study in the Pediatrics journal indicates that there is very little chance of transmission with appropriate antiretroviral therapy (ART) and an undetectable viral load.
Still, the AAP emphasizes that the only choice that totally removes the chance of HIV transmission after birth is formula or approved donor milk. But the new recommendations urge physicians to help and advise HIV-positive women who want to breastfeed as long as they are on antiretroviral therapy and have an undetectable viral load.
Reasons to Breastfeed
Living with HIV for almost 20 years, LaTonya knew she wanted to nurse her son because of the many health advantages nursing provides, including lower risk of asthma, obesity, type 1 diabetes, and sudden infant death syndrome. Mommyhood is a wonderful thing. Not for the world would I swap it,” she declared. “Giving my son the best start in life involved breastfeeding.”
Following their discussion of her choice, her doctors created a safe breastfeeding plan for her, stressing the need of ongoing observation and rigorous adherence to her medication. “You cannot pass it on to your partner or your child if you’re undetectable,” LaTonya said. “Why then deny your child the advantages of nursing?”
Science Backing Up the Adjustment
Antiretroviral medications have been found in research to drastically lower the chance of HIV spreading through nursing. In the first four to six weeks of life, when ART is not used, the risk of transmission through breast milk is greatest, between 5% and 6%. But the risk is less than 1% with ART and an undetectable viral load.
Lead author of the study, Colorado pediatrician Dr. Lisa Abuogi, said, “The AAP is now specifically emphasizing that pregnant women with HIV who are on treatment and undetectable can be supported to breastfeed. People with HIV have been pushing for this shift for a long time.”
Getting Over Stigma and Offering Help
Because they thought nursing would reveal their HIV status, moms who tested positive for the virus in the past experienced shame and sorrow. By giving them the same alternatives for nursing their babies as any other mother, the new recommendations seek to empower these women.
Pediatric infectious disease specialist Dr. Rana Chakraborty of Mayo Clinic stressed that a multidisciplinary team is needed to ensure safe breastfeeding when a mother has HIV. “To make sure it’s done safely for both mom and baby, you need support,” he said.
Planning Ahead
The new AAP stance is consistent with revised guidelines from the U.S. Department of Health and Human Services (HHS), which also advise breastfeeding for HIV-positive moms on antiretroviral therapy (ART) with undetectable viral loads. This consensus, according to Dr. Elaine Abrams of Columbia University, places the mother at the center of the decision-making process and gives her information and backing.
Because formula feeding in such circumstances has health hazards, the World Health Organization has long advised breastfeeding for mothers with HIV in areas without safe drinking water or easily available formula. ART successfully lowers the risk of HIV transmission while nursing, according to studies.
LaTonya believes that improved public education on HIV will result from the new suggestions. “It is not something to be afraid of, people need to realize,” she remarked. “Doctors should discuss HIV during routine tests more to dispel outdated fears and misconceptions.”
Finally, the new AAP recommendations represent a major advancement in the support of HIV-positive moms by providing them with the chance to safely breastfeed while getting the required medical attention and counseling. This adjustment attempts to lessen the stigma and false information around HIV while recognizing the value of breastfeeding.