Breastfeeding

  • During breastfeeding, HIV can be transmitted from an HIV-positive mother to her baby.
  • In the UK and other countries where safe alternatives are available, it is recommended that HIV-positive women do not breastfeed their babies.
  • If an HIV-positive woman decides to breastfeed, it is then safer to do so exclusively, and the risk of transmission is reduced if she and the child are on antiretroviral treatment.

The first evidence that HIV could be transmitted via breast milk was a case report of the child of a previously healthy woman who was delivered by caesarean section. Because of blood loss from the operation, the mother was given a blood transfusion after the delivery. The baby was breastfed for six weeks. Later, it was discovered that a unit of the transfused blood had been contaminated with HIV. The mother and her infant were subsequently found to have both become infected.1

Moreover, HIV transmission after childbirth (in medical language, ‘postpartum’) is known to occur because some infants test negative for HIV RNA one month after birth, but test positive later on.

HIV can be detected in breast milk. Three HIV reservoirs coexist in breast milk: RNA (cell-free viral particles), proviral DNA (cell-associated virus integrated in latent T-cells) and intracellular RNA (cell-associated virus in activated producing T-cells). The respective role of each in HIV transmission is poorly understood.

Moreover, if the nipples are cracked or bleeding, blood may transmit the virus too.

The Breastfeeding and HIV International Transmission Study, which analysed data from 4085 infants in nine different African studies, found that between 24 and 42% of infants breastfed by an HIV-positive mother acquired HIV.2

In the absence of any interventions to reduce the risk of infection, breastfeeding is thought to account for between one third and one half of mother-to-child transmissions.3 However in practice, the proportion of infections which are due to breastfeeding will vary between different populations, because the proportions of women who take HIV treatment and who breastfeed vary.

In the UK and other rich countries, guidelines recommend that HIV-positive women should refrain from breastfeeding and should use formula feed.

See also

In many resource-limited settings, the lack of access to clean water means that the risk of HIV transmission through breastmilk must be weighed against the risks of infant malnutrition, infections and mortality posed by formula feeding.

The World Health Organization (WHO) recommends an “either-or” approach based on available resources. HIV-positive mothers with infants who are not known to be HIV-positive should either:

  • avoid breastfeeding altogether, or
  • breastfeed with accompanying prophylactic antiretroviral therapy to lower the risk of HIV transmission.

Should antiretroviral drugs not be available, breastfeeding may still be recommended to HIV-positive mothers.

References

  1. Ziegler JB et al. Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet 1: 896-898, 1985
  2. The Breastfeeding and HIV International Transmission Study Group Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis. J Infect Dis. 189:2154-2166, 2004
  3. Lehman DA & Farquhar C Biological mechanisms of vertical immunodeficiency virus (HIV-1) transmission. Rev Med Virol 17: 381-403, 2007
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