US pediatricians reverse decades-old advice against HIV-positive mothers breastfeeding

May 20, 2024  -People with HIV can breastfeed their babies, as long as they are taking medications that effectively suppress the virus that causes AIDS, a top U.S. pediatricians’ group said Monday in a sharp policy change.

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

It recognizes that routinely prescribed drugs can reduce the risk of transmitting HIV via 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 engage in shared decision-making,” Abuogi said.

AP correspondent Ed Donahue reports on new rules for moms with HIV.

The drugs, known as antiretroviral therapy, don’t eliminate all risk of transmitting HIV through breast milk. Avoiding breastfeeding is the only certain way to prevent spreading the virus, Abuogi said.

In addition, parents must breastfeed exclusively for the babies’ first six months because research shows that switching between breast milk and formula can disrupt an infant’s gut in ways that increase the risk of HIV infection.

About 5,000 people who have HIV give birth in the U.S. each year. Nearly all take drugs to suppress the virus to very low levels, Abuogi said, though viral levels can rebound if they don’t stay on them.

Before the medications became widely available starting a decade ago, about 30% of HIV infections transmitted from moms to babies occurred during breastfeeding, said Dr. Lynne Mofenson, an adviser to the Elizabeth Glaser Pediatric AIDS Foundation. In the early 1990s, about 2,000 infections occurred in U.S. infants each year. Today, it’s fewer than 30.

The AAP policy comes more than a year after the National Institutes of Health and the Centers for Disease Control and Prevention reversed longstanding recommendations against breastfeeding by people with HIV. That guidance said people who have consistent viral suppression should be counseled on their options. It also emphasizes that health care providers shouldn’t alert child protective services agencies if a parent with HIV seeks to breastfeed.

Leave a Reply

Your email address will not be published. Required fields are marked *