Pediatricians say HIV positive mothers can breastfeed

PPeople with HIV can breastfeed their babies as long as they take medications that effectively suppress the virus that causes AIDS, a leading group of U.S. pediatricians said Monday in a radical shift in policy.

The new report from the American Academy of Pediatrics reverses recommendations that had been in place since the start of the HIV epidemic in the 1980s.

It recognizes that routinely prescribed medications can reduce the risk of transmitting HIV through breast milk to less than 1%, said Dr. Lisa Abuogi, a pediatric HIV expert at the University of Colorado and lead author of the report.

“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 participate in shared decision making,” Abuogi said.

The medications, known as antiretroviral therapy, do not eliminate all risks of transmitting HIV through breast milk. Avoiding breastfeeding is the only sure way to prevent the spread of the virus, Abuogi said.

Additionally, parents should exclusively breastfeed their babies for the first six months because research shows that switching between breast milk and formula can upset the baby’s gut in ways that increase the risk of HIV infection.

Read more: HIV rates in the United States are falling. But progress is not equal

About 5,000 people with HIV give birth in the U.S. each year. Almost everyone takes medications to suppress the virus to very low levels, Abuogi said, although viral levels can rebound if not maintained on them.

Before drugs became widely available a decade ago, about 30% of HIV infections passed from mothers to babies occurred during breastfeeding, said Dr. Lynne Mofenson, an adviser to the Elizabeth Glaser Foundation for Pediatric AIDS. In the early 1990s, about 2,000 infections occurred in American babies each year. Today there are less than 30.

The AAP policy comes more than a year after the National Institutes of Health and the Centers for Disease Control and Prevention rescinded long-standing recommendations against breastfeeding by people with HIV. That guidance said people who have ongoing viral suppression should be counseled about their options. He also emphasizes that health care providers should not alert child protective services agencies if a parent with HIV attempts to breastfeed.

The goal is to listen to patients “and not blame or shame them,” said Dr. Lynn Yee, a professor of obstetrics and gynecology at Northwestern University who helped write the NIH guidance.

Breastfeeding provides ideal nutrition for babies and protects them against diseases and conditions such as obesity and type 2 diabetes, research shows. Breastfeeding also reduces the mother’s risk of breast and ovarian cancer, diabetes, and high blood pressure.

Read more: The radical joy of breastfeeding my 3-year-old son

The World Health Organization has recommended since 2010 that women with HIV in developing countries breastfeed their babies and have access to antiretroviral therapy. The guidance weighed the risk of babies contracting HIV through breastfeeding and the risk of babies dying from malnutrition, diarrhea and pneumonia in places where there are no safe substitutes for breast milk.

However, in developed countries, experts had recommended against breastfeeding because the wide availability of safe water, formula and human donor milk could eliminate the risk of HIV transmission, Yee said.

This frustrated people with HIV who were flatly denied the option to breastfeed.

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

“I couldn’t understand how my sister who lives in a place like Kenya, who looks like me with the same brown skin color, was given the option to breastfeed and how my choice was adamantly no,” she said.

Not being able to breastfeed her son sent Covin into a spiral of postpartum depression, she said. When she became pregnant with her daughter Zuri, now 2 years old, her health care team helped her successfully breastfeed for seven months. Covin took her prescriptions as directed and also gave the baby medication to prevent infections.

“Breast milk contains everything my baby would need,” Covin said. “That’s a beautiful thing.”

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

Some providers were already helping people treated for HIV breastfeed their babies, despite previous recommendations. The new guidance should expand the practice, hopefully quickly, Abuogi said.

“This is a unique situation because it’s not just the doctors and providers that are changing,” Abuogi said. “Our patients are driving this too.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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