The Aryavarth Express
Agency (New Delhi): The American Academy of Pediatrics (AAP) announced a significant policy change on Monday, stating that individuals with HIV can breastfeed their babies if they are taking medications that effectively suppress the virus. This new guidance reverses recommendations that have been in place since the onset of the HIV epidemic in the 1980s.
Dr. Lisa Abuogi, a pediatric HIV expert at the University of Colorado and lead author of the report, emphasized that routinely prescribed antiretroviral drugs can reduce the risk of transmitting HIV via breast milk to less than 1%. “The medications are so good now and the benefits for mom and baby are so important that we are at a point where it is important to engage in shared decision-making,” Abuogi stated.
However, Abuogi noted that while these drugs significantly reduce the risk, they do not eliminate it entirely. The only certain way to prevent HIV transmission through breastfeeding is to avoid it altogether. Additionally, parents must exclusively breastfeed for the first six months, as alternating between breast milk and formula can disrupt an infant’s gut, increasing the risk of HIV infection.
Approximately 5,000 people with HIV give birth annually in the US. Nearly all of them take antiretroviral drugs to suppress the virus to very low levels, though these levels can rebound if the medications are not consistently taken. Before the widespread availability of these medications about a decade ago, around 30% of HIV transmissions from mother to child occurred during breastfeeding. In the early 1990s, this led to about 2,000 infections in US infants each year, a number that has now dropped to fewer than 30.
This policy change by the AAP follows similar revisions by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) more than a year ago. These agencies now recommend that people with consistent viral suppression be counseled on their breastfeeding options and emphasize that healthcare providers should not report parents with HIV who choose to breastfeed to child protective services.
Dr. Lynn Yee, a Northwestern University professor of obstetrics and gynecology who helped draft the NIH guidance, highlighted the importance of listening to patients without blaming or shaming them. Breastfeeding offers numerous benefits, including ideal nutrition for babies, protection against illnesses, and reduced risks of obesity and Type 2 diabetes. It also lowers the mother’s risk of breast and ovarian cancer, diabetes, and high blood pressure.
Since 2010, the World Health Organization (WHO) has recommended that women with HIV in developing countries breastfeed their infants if they have access to antiretroviral therapy. This recommendation balances the risk of HIV transmission with the dangers of malnutrition, diarrhea, and pneumonia in places where safe alternatives to breast milk are not available. In contrast, experts in developed nations had previously advised against breastfeeding due to the availability of safe water, formula, and donor milk, which could eliminate the risk of HIV transmission.
The AAP’s new guidance aims to provide crucial support for pediatricians, nurses, and lactation specialists. Dr. Abuogi noted that some healthcare providers had already been assisting HIV-positive individuals with breastfeeding despite previous recommendations, and she hopes the new guidance will expand this practice quickly.
One example of the impact of this policy change is Ci Ci Covin, 36, of Philadelphia, who was diagnosed with HIV at age 20. She was not permitted to breastfeed her first child, leading to postpartum depression. However, with her second child, Covin was able to successfully breastfeed for seven months with the support of her healthcare team, while adhering to her medication regimen and giving her baby preventive drugs.
“Breast milk has everything in it that my baby would need,” Covin said. “That’s a beautiful thing.”
Abuogi highlighted that this policy change is being driven not only by healthcare providers but also by the patients themselves, who are pushing for these options.