[Policy Statement] AAP urges bottle feeding over breastfeeding in mothers with HIV

Jan 28th – The American Academy of Pediatrics (AAP) recommends that HIV-infected mothers in the United States not breastfeed their infants, regardless of viral load or adherence to antiretroviral therapy.

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Image: CC/Azoreg

In a statement released today,

 1. The AAP recommends that HIV-infected mothers in the United States not breastfeed their infants, regardless of viral load or adherence to antiretroviral therapy.

 
2. The AAP recommends routine prenatal HIV testing, as well as postnatal testing for women at high risk for HIV infection.
 
3. The AAP encourages human milk banks and NICUs to stringently follow US Public Health Service guidelines, including screening donors for HIV and pasteurizing donated human milk. 

An AAP policy statement released today highlights the importance of counseling HIV-positive mothers in the United States against breastfeeding to prevent maternal-child transmission of the virus. Although studies have shown a decreased risk of transmission via breastfeeding from mothers adherent with antiretroviral therapy who have a low viral load, the risk of HIV transmission is never completely eliminated. The World Health Organization recommends that HIV-infected mothers in resource-poor settings, where replacement feeding is not feasible, breastfeed for the first six months of life with adjunctive postnatal maternal and infant antiretroviral therapy. In the United States, however, where clean water is accessible and formula is affordable, the AAP recommends that infants of HIV-positive mothers be formula-fed. The AAP additionally recommends that all women undergo routine prenatal testing for HIV, and that women at high risk for HIV infection also be tested postnatally in order to enable individualized counseling regarding the risks of breastfeeding. The AAP also identifies the potential risk of transmitting HIV through donor human breast milk and encourages all human milk banks and NICUs to screen donors for HIV and to pasteurize donated milk to eradicate the virus.

Further reading:

• WHO collaborative study: Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries
• AAP policy statement: Prevention of mother to child HIV transmission
• CDC breastfeeding recommendations

Click to read the AAP policy statement, released today

By [EH] and [DB]

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Emilia Hermann: Emilia is a 3rd year MD candidate at the University of Pennsylvania.

Devika Bhushan: Devika is a 4th year M.D. candidate at Harvard Medical School.

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