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Every time Latonia looks at the framed photos of her first breastfeeding baby, she gets emotional.
As a mother living with HIV in Colorado, it was a time she wanted to remember.
“How important it was to me to be able to breastfeed,” Latonia said of the photos. “So I wanted to make sure we had that forever.”
For the first time, the American Academy of Pediatrics has reversed its position, saying that people with HIV, the human immunodeficiency virus, can breastfeed their babies “to a very limited extent” if they follow certain guidelines and have the support of their medical team.
Avoiding breastfeeding is the only option that has zero risk of HIV transmission, but in the future, pediatricians should offer support and advice to those who want to breastfeed, as prescribed antiretroviral therapy, known as ART, to reduce the virus in the body, according to a new AAP clinical report published Monday. Journal of Pediatrics.
Formerly of Academy is recommended Mothers with HIV in the United States are not Breastfeeding their childrenRegardless of viral load and antiretroviral therapy use.
Recommendations against breastfeeding for people with HIV The US Centers for Disease Control and Prevention recommended it in 1985. Women infected with HIV should avoid breastfeeding..
“The AAP recommends that replacement feeding (formula or certified banked donor human milk) is the only 100% effective way to prevent postpartum HIV transmission for people living with HIV in the United States,” the new says a report. “However, pediatric health care professionals must be prepared to provide infant feeding counseling on ART and a family-centered, culturally sensitive, harm reduction approach to HIV-infected individuals who wish to breastfeed.”
HIV is a virus that attacks the body's immune system and, if left untreated, can lead to immunodeficiency syndrome or AIDS.
Latonia says she has been living with HIV for 20 years, but knew she wanted to breastfeed for health reasons after giving birth to her son. Benefits of breastfeeding for newbornsincluding an association with lower risk of asthma, obesity, type 1 diabetes and sudden infant death syndrome.
“Being a mother is an amazing thing. I wouldn't change it for the world,” added Latonia, adding that every parent wants to give their child the “best shot” at becoming a good person.
“I feel like I can provide breastfeeding for him,” she said of her son.
After discussing her decision with her doctors, they made a plan for her to breastfeed because her viral load was unknown and she was taking antiretroviral drugs.
They discussed “permanent viral load monitoring” to ensure there was no increase in her viral load And “full adherence to medication was important,” Latonia said. is not publishing her full name to protect her medical privacy.
“I think it's really important that people understand the science behind it,” she said. If it is unknown, you cannot transfer it to your partner. It is important for people to understand that, if you follow your medication strictly, it will not be passed on to your baby through breast milk. And so, why would you deny your child… from having that benefit?”
Although HIV can be transmitted to children through breastfeeding, research has shown that the use of anti-HIV drugs is possible. It can significantly reduce the risk of HIV transmission.And these Medicines are found to be safe During breastfeeding.
If the mother is not taking ART or the infant is not taking antiretroviral drugs, the risk of exposure to HIV through breast milk is 5% to 6% in the first four to six weeks of life, according to the APAP. Report it.
But if the mother is taking antiretroviral drugs and the virus is suppressed in her body, it is “estimated to be less than 1%,” meaning there is no detectable viral load, the report said.
“What's really new about AAP is that it's the first time that HIV-positive pregnant women and people who are on treatment and undiagnosed can breastfeed,” said lead author of the report Dr. Lisa Abuogi, a pediatrician who practices in Colorado. With people who have HIV during pregnancy.
“This has been a long evolution, and people living with HIV are part of the advocacy for this change,” Abuogi said. “Some women feel ashamed or anxious or feel like they're not fulfilling their role as mothers if they can't breastfeed, and some worry that it will reveal their HIV status in their community – if breastfeeding is normal and why you shouldn't.”
It is assumed that About 5,000 people infected with HIV They give birth every year in the United States.
“So having the opportunity to present the choice to women like all women have and to support their decisions is really powerful,” Abuogi said. “People living with HIV should have the same infant feeding options as everyone else, and we're really working to make it safer for women.”
Last year, a US Department of Health and Human Services advisory panel did the same Updates on his recommendations Regarding breastfeeding, “Persons with HIV who have a persistent undetectable viral load on ART and who choose to breastfeed should be supported in this decision.”
Dr. Rana Chakraborty, a pediatric infectious disease specialist and researcher, said the new AAP position is consistent with updated recommendations from the HHS panel. Mayo Clinic In Minnesota, who is Member of HHS Panel on HIV treatment and prevention of perineal transmission during pregnancy.
“This is an issue that has been discussed for a few years now. It was started by a panel of the Department of Health and Human Services, and I think the authors of this report summarized very well the current national guidelines in the U.S. that came out of the AAP,” said Chakraborty, who was not involved in the new AAP report.
Several investigators, many from the US working in relatively resource-limited settings, have previously shown that breastfeeding is safe if the mother is taking antiretroviral therapy and maintains an undetectable HIV viral load. The virus in a drop of blood should be less than 50 copies per milliliter, he said. “In America, this is also possible. However, breastfeeding during maternal HIV infection requires a supportive multidisciplinary team of providers to ensure that it is safe for both mother and baby.
The AAP's recommendations indicate a consensus among medical groups that mothers living with HIV can now be supported and counseled on breastfeeding safely, said Dr. Elaine Abrams, MD, professor of epidemiology and pediatrics. Columbia University Medical Center in New York, which treated people with HIV during pregnancy and postpartum but was not involved in the new AAP report.
“All the bodies that provide guidance to medical professionals are now saying the same thing. We are seeing consensus, and the consensus is to put the mother at the center of the conversation and decision-making,” she said.
“It went from telling her what to do, to understanding what she wanted to do, to providing evidence and information and supporting her in her decision,” Abrams added. “In the old days, it wasn't like that.
In the year In the early 2000s, studies emerged that showed an increase in the number of babies born to HIV-infected women in low-income countries. Disease risks And Death When they were given formula — and mothers didn't have access to clean drinking water to mix with formula — it was found to be linked, according to a new AAP report. That's what motivated him World Health Organization To advise people living with HIV to breastfeed their babies where there is no safe drinking water and no accessible formula.
Many studies have found that mothers with HIV are breastfeeding When the mother is taking ART or because the baby is less likely to develop anti-HIV antibodies.
According to the new AAP report, there is no consensus on the optimal route of antiretroviral therapy for infants during breastfeeding. Also, those who are breastfeeding are advised to do so exclusively because mixing breastfeeding with formula or solid foods is associated with increased HIV transmission.
“This increase may be due to impaired infant gut integrity associated with feeding other substances than human milk, reduced levels of antiviral or anti-inflammatory substances commonly found in human milk, or other mechanisms,” according to the AAP report.
Latonia said one of the breastfeeding guidelines her medical team discussed was not to exclusively breastfeed with formula.
“One of the rules we're taught is that if we want to breastfeed, it's the only thing we can do,” says Latonia. “We can't mix formula and breastfeeding.”
Along with supporting and counseling HIV-infected patients who want to breastfeed, the AAP recommends in the new report that pregnant women be routinely tested for HIV and that those with HIV in their bloodstream or newly diagnosed be linked to treatment.
Latonia said the new AAP recommendations encourage health care providers to educate the public more about what HIV is, how to treat the infection and how to prevent the virus.
“It's something people live with, and it's not something to be afraid of,” Latonia said.
She says the only time doctors have such an educational conversation with their patients is when someone gets a routine HIV test.
They talk about gonorrhea and chlamydia but the HIV part is missing. And so, a lot of people are still stuck in the '80s thinking about HIV and AIDS,” Latonia said. “I believe this is largely due to lack of education.”