Evolution of the Guidelines
In 2010, WHO for the first time recommended antiretroviral (ARV) drug interventions to prevent postnatal transmission of HIV through breastfeeding (BF). In the same year, the guidelines on HIV and infant feeding were updated to advise national authorities to promote and support one feeding practice to all women living with HIV accessing care in health facilities.
The WHO consolidated guidelines on the use of ARV drugs for treating and preventing HIV infection were updated in 2013 and again in 2016. WHO now recommends lifelong ART for everyone from the time when any adult (including pregnant and breastfeeding women) or child is first diagnosed with HIV infection. These revisions to the ARV drug guidelines, recent evidence and programmatic experience and demand for clarification on specific issues created a need to review the HIV and infant feeding guidelines.
The objective of this guideline is:
- to improve the HIV-free survival of HIV-exposed infants by providing guidance on appropriate infant feeding practices and use of ARV drugs for mothers living with HIV
The recommendations revolve around four main areas:
- the duration of BF by mothers living with HIV
- interventions to support infant feeding practices by mothers living with HIV
- what to advise when mothers living with HIV do not exclusively breastfeed
- what to advise when mothers living with HIV do not plan to breastfeed for 12 months
Key recommendations (duration and interventions)
- Mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or longer (similar to the general population) while being fully supported for ART adherence (see the WHO consolidated guidelines on ARV drugs for interventions to optimize adherence)
- National and local health authorities should actively coordinate and implement services in health facilities and activities in workplaces, communities and homes to protect, promote and support breastfeeding among women living with HIV.
Guiding Practice Statements (EBF and non-breastfeeding)
- Mothers living with HIV and health-care workers can be reassured that ART reduces the
risk of postnatal HIV transmission in the context of mixed feeding. Although exclusive
breastfeeding is recommended, practising mixed feeding is not a reason to stop breastfeeding in the presence of ARV drugs.
- Mothers living with HIV and health-care workers can be reassured that shorter durations of
breastfeeding of less than 12 months are better than never initiating breastfeeding at all.
- The rationale for promoting breastfeeding (BF) among children born to women living with HIV (WLHIV) is the same as for all children: breastfeeding gives all children the best start in life and improves child survival
- For women living with HIV who choose to breastfeed, ART adherence is of critical importance to reduce the risks of transmission during the post-natal period and enjoy the health benefits of breastfeeding
- Taking ARVs while breastfeeding protects the health of the mother AND provides benefits to the long-term survival of the child
- Breastfeeding for any duration offers more benefits to the child that not breastfeeding at all; the most benefit is incurred during the first 12 months
- Essentially, the recommendations on breastfeeding are similar for all women regardless of HIV status
- The guidelines speak to the recommendations that health services should promote breastfeeding, however the choice and for how long to breastfeed rests with the woman taking into account her individual circumstances.
The guideline update can be found here.
Source: The Interagency Task Force