Historic Change in Recommendations by the American Academy of Pediatrics
A significant policy change was announced on Monday, May 20, by a leading American pediatric organization, stating that women living with HIV can safely breastfeed their children, provided they are on effective antiretroviral drugs that suppress the virus-causing AIDS.
Reversal of decades-old guidelines
The American Academy of Pediatrics (AAP) has reversed its longstanding recommendations dating back to the 1980s, at the height of the HIV epidemic. The shift acknowledges the advancements in HIV treatment and the importance of breastfeeding for both mother and child.
Expert insights on the new guidelines
“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,” stated Lisa Abuogi, the lead author of the report.
While antiretroviral treatments do not eliminate the risk of HIV transmission through breast milk, the AAP emphasizes that the benefits outweigh the risks if the virus is effectively suppressed. Abuogi notes that the only sure way to prevent transmission is to avoid breastfeeding, but exclusive breastfeeding is recommended for the first six months to avoid digestive issues that can increase infection risks.
Approximately 5,000 HIV-positive women give birth annually in the United States
Approximately 5,000 HIV-positive women give birth annually in the United States. Abuogi highlights that nearly all of these women use medications to keep the virus at very low levels, though discontinuation of these drugs can lead to a resurgence of the infection.
The AAP’s new stance aligns with recent recommendations from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). These organizations advocate for counseling on options for those consistently suppressing their virus and advise against involving child protective services if an HIV-positive parent chooses to breastfeed.
Research indicates that breastfeeding provides optimal nutrition for infants and protects against diseases and conditions such as Type 2 diabetes and obesity.
Global health recommendations
Since 2010, the World Health Organization (WHO) has recommended antiretroviral medication and breastfeeding for HIV-positive mothers in developing countries. However, in developed countries, specialists have typically advised against breastfeeding due to the availability of safe alternatives like clean water, formula, and donor milk, which eliminate the risk of HIV transmission.
This groundbreaking policy shift by the AAP reflects the significant advancements in HIV treatment and the growing recognition of the critical benefits of breastfeeding, marking a new era in pediatric healthcare and HIV management.