U.S. pediatrician group lifts decades-old ban on breastfeeding women infected with HIV

A group of top U.S. pediatricians on Monday made a major change in policy, saying people with HIV can breastfeed their babies as long as they take drugs that effectively suppress the virus that causes AIDS. Announced.

A new report from the American Academy of Pediatrics reverses recommendations the organization has made since the beginning 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, acknowledged that regularly prescribed medications can reduce the risk of transmitting HIV through breast milk to less than 1%. Stated.

“We are now at a point where it is important to engage in shared decision-making because the efficacy of medicines is so great and the benefits for mothers and babies are so important,” Abuogi said. Stated.

This medicine, known as antiretroviral therapy, does not eliminate all risk of transmitting HIV through breast milk. Abuogi said avoiding breastfeeding is the only sure way to prevent the spread of the virus.

Additionally, parents should exclusively breastfeed their infants for the first six months, as studies have shown that switching between breast milk and formula can confuse infants' intestines and increase the risk of HIV infection. It doesn't have to be.

Approximately 5,000 people with HIV are born in the United States each year. Abuogi said almost everyone is taking medication that keeps the virus at very low levels, but if they don't continue taking the medication, virus levels can rebound.

Before the drug became widely available a decade ago, about 30% of HIV infections passed from mothers to infants occurred during breastfeeding, said Dr. Lynn Moffenson, a consultant at the Elizabeth Glaser Pediatric AIDS Foundation. It is said that In the early 1990s, about 2,000 infections occurred in U.S. infants each year. Today there are less than 30 people.

The AAP policy was announced more than a year after the National Institutes of Health and the Centers for Disease Control and Prevention rescinded long-standing recommendations against breastfeeding by people with HIV. The guidance says people who have consistently suppressed the virus should be advised about their options.It also emphasizes that health care Health care providers should not alert child protective services agencies if an HIV-infected parent wishes to breastfeed.

Dr. Lin Yi, a professor of obstetrics and gynecology at Northwestern University who helped draft the NIH guidance, said the goal is to listen to patients and “not to blame or shame them.” he said.

Research shows that breastfeeding provides ideal nutrition for babies and protects them from diseases and conditions such as obesity and type 2 diabetes. Breastfeeding also reduces a mother's risk of breast cancer, ovarian cancer, diabetes, and high blood pressure.

Since 2010, the World Health Organization has recommended that HIV-infected women in developing countries breastfeed their infants and receive antiretroviral therapy. The guidance weighed the risk of infants acquiring HIV through breastfeeding against the risk of infants dying from malnutrition, diarrhea, and pneumonia in places where safe breast milk substitutes are not available.

But in developed countries, experts recommend against breastfeeding because the widespread availability of safe water, infant formula and human donor milk eliminates the risk of HIV infection, Yi said.

This frustrated HIV-infected people who were flatly denied the option of nursing.

Ci Ci Cobin, 36, of Philadelphia, said she was diagnosed with HIV at age 20 and is not allowed to breastfeed her first child, Zion, now 13.

“Living in a place like Kenya, I couldn't understand why my sister, who has the same brown skin and looks just like me, was given the option to breastfeed and mine was a flat out no,” she said.

Unable to breastfeed her son, Cobin said she spiraled into postpartum depression. When she became pregnant with her now two-year-old daughter Zuri, her medical team helped her be able to breastfeed for her seven months. Cobin followed her instructions and took the prescription, giving the baby medication to prevent the infection.

“Breast milk contains everything a baby needs,” Cobbin said. “That's a beautiful thing.”

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

Some health care providers were assisting people already receiving treatment for HIV to breastfeed their infants, despite previous recommendations. Abuogi said the new guidance should lead to expanded practice, hopefully quickly.

“This is a unique situation because it's not just doctors and health care providers that are changing,” Abuogi said. “Our patients are also driving this.”

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