PPeople with HIV can breastfeed their babies as long as they take medicines that effectively suppress the virus that causes AIDS, a leading group of US pediatricians said on Monday, in a radical change of policy.
The new report from the American Academy of Pediatrics reverses recommendations that have been in place since the start of the HIV epidemic in the 1980s.
It recognizes that routinely prescribed medications can reduce the risk of HIV transmission through breast milk to less than 1%, said Dr. Lisa Abuogi, a pediatric HIV specialist at the University of Colorado and lead author of the report.
“The medicines are so good now and the benefits for mother and baby are so important that we have reached a point where it is important to participate in shared decision-making,” Abuogi said.
Medicines, known as antiretroviral therapy, do not eliminate all risks of HIV transmission through breast milk. Avoiding breastfeeding is the only safe way to prevent the spread of the virus, Abuogi said.
Additionally, parents should breastfeed exclusively for their babies’ first six months because research shows that switching between breast milk and formula can upset a baby’s gut in ways that increase the risk of HIV infection.
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About 5,000 people who have HIV give birth in the US every year. Almost everyone takes medication to suppress the virus to very low levels, Abuogi said, although viral levels can rebound if they don’t stay there.
Before the drugs became widely available a decade ago, about 30% of HIV infections passed from mothers to babies occurred during breastfeeding, said Dr. Lynne Mofenson, counselor at the Elizabeth Glaser Pediatric AIDS Foundation. In the early 1990s, approximately 2,000 infections occurred annually in North American children. Today there are less than 30.
The AAP’s policy comes more than a year after the National Institutes of Health and the Centers for Disease Control and Prevention reversed long-standing recommendations against breastfeeding for people with HIV. That guidance said that people who have consistent viral suppression should be counseled about their options. It also emphasizes that health care providers should not alert child protective services agencies if a parent with HIV intends 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 hypertension.
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Since 2010, the World Health Organization has recommended that women with HIV in developing countries breastfeed their children and have access to antiretroviral therapy. The guidance assessed the risk of babies acquiring HIV through breastfeeding and the risk of babies dying from malnutrition, diarrhea and pneumonia in settings where there are no safe substitutes for breast milk.
In developed countries, however, experts have recommended against breastfeeding because the widespread availability of clean water, formula and human donor milk could eliminate the risk of HIV transmission, Yee said.
This frustrated people with HIV, who were categorically denied the option of breastfeeding.
Ci Ci Covin, 36, of Philadelphia, said she was diagnosed with HIV at age 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 and has the same dark skin color, had the choice to breastfeed and how my choice was completely negative,” 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, her healthcare team helped her breastfeed successfully for seven months. Covin took prescriptions as instructed and also gave the baby medication to prevent infections.
“Breast milk contains everything my baby needs,” Covin said. “This is 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 doctors and providers who are changing,” Abuogi said. “Our patients are encouraging this too.”
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This story originally appeared on Time.com read the full story
