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

(AP) – In a radical policy change, a group of top U.S. pediatricians said Monday that people with HIV should not breastfeed their babies as long as they are taking drugs that effectively suppress the virus that causes AIDS. announced that it could be given.

of new report The American Academy of Pediatrics' recommendations reverse recommendations that have been in place 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 breastfeed their babies exclusively for the first six months of life, as studies have shown that switching between breast milk and formula can disrupt a baby's intestines and increase the risk of HIV infection.

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 by the National Institutes of Health and the Centers for Disease Control and Prevention more than a year ago. overturn long-standing recommendations Breastfeeding by people infected with HIV is prohibited. The guidelines say people whose virus is consistently suppressed should receive counseling about their options. It also emphasizes that health care workers should not notify child protective services if a parent with HIV infection wishes to breastfeed.

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

Studies have shown that breastfeeding provides optimal nutrition for babies and protects against diseases and conditions such as obesity and type 2 diabetes. Breastfeeding also reduces the mother's risk of breast cancer, ovarian cancer, diabetes and high blood pressure.

The World Health Organization recommends Since 2010 Access to HIV-infected women in developing countries to 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.

However, in developed countries, experts recommend against breastfeeding because the risk of HIV infection can be eliminated if safe water, baby formula and human donor milk are widely available, 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.

“I don't understand that in a place like Kenya, my sister, who has exactly the same brown skin as me, has the option to breastfeed, but I can't explicitly acknowledge that option. I did,” she said.

She says not being able to breastfeed her son sent Cobin into a vicious cycle of postpartum depression. When she became pregnant with her now two-year-old daughter Zuri, her medical team helped her breastfeed for seven months. Cobin took her prescribed medication as directed and also gave the baby medication to prevent infections.

“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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