HIV AND BREASTFEEDING

HIV infection is regarded as a chronic condition, in the same way as diabetes or hypertension (high blood pressure). 

A yearly HIV test is recommended to know your status. [1] If you are living with HIV, you can live a long healthy life if you:

  • take your anti-retroviral (ARV) treatment every day

  • eat healthy foods

  • maintain a healthy lifestyle, e.g. not smoking

  • fit in moderate exercise, and 

  • avoid risky behaviour such as taking drugs or having many sexual partners. 

 

HIV AND PREGNANCY

One in five women of child-bearing age in South Africa are HIV positive. [2] But of all the babies born to HIV positive mothers, less than 1% are born HIV positive. [1] In most instances where the baby is infected, the mother has not taken her medication as she should have. 

It is very important that all people living with HIV take their antiretroviral medicines every day. Antiretrovirals suppress or lower the amount of virus (viral load) in your body. 

If you are HIV positive and planning to have a baby, aim to have viral loads lowered (<1000c/ml) for at least 4 months before falling pregnant [1] In most cases, your blood result is likely to show an undetectable viral load, if you have been compliant with your medication.

Once you’re pregnant, make sure you attend all your antenatal clinic visits. This ensures that you and your baby can be monitored throughout the pregnancy. You will have regular blood checks to make sure your viral load remains low (<1000c/ml). This protects your baby from getting HIV from you. Your baby will also receive some antiretroviral medicines as a further precaution after birth. [1] 

ONCE BABY IS THERE

Try to keep your baby in direct skin to skin contact for as long as possible. Direct skin to skin contact, also known as kangaroo mother care, helps to get breastfeeding off to a good start. It also helps to prevent baby from losing too much weight and getting neonatal jaundice. 

BREASTFEEDING WHILE HIV+

You may be wondering if breastfeeding is the right choice for you if you’re HIV infected. Studies show that if you take your ARVs daily and have a suppressed viral load, there is an almost negligible risk of transmission of HIV to your baby. [1][3]

The most important benefit of exclusive breastfeeding is the reduction in the risk of HIV transmission and improved child survival. [4] 

Exclusive breastfeeding for the first 6 months of a child’s life, means that baby gets nothing else to eat or drink other than breastmilk. Anything else at all - water, tea, formula, solid food, will increase the risk of HIV transmission and other illnesses, reducing child survival. 

Exclusive breastfeeding is recommended for the first 6 months of a child’s life. [1][3][4] This means no extra water, porridge or foods, are needed.

Exclusive breastfeeding itself, protects babies from HIV transmission, as well as giving the baby the best chance of good health. [4]

Although exclusive breastfeeding is recommended, practicing mixed feeding with formula milk is not a reason to stop breastfeeding in the presence of ARV drugs. [1][4]

Breastfeeding is recommended for at least 24 months for ALL babies. 

A shorter duration of breastfeeding of less than 12 months is better than never breastfeeding at all. [4]

 

WEANING OF BREASTMILK WHEN HIV+

If you decide to stop breastfeeding, do so gradually over a period of a month. Stopping breastfeeding abruptly is not recommended and may increase the viral load in breastmilk. [1]

WHAT IF YOU BECOME ILL?

If you become sick or are hospitalised, consider ways you can continue breastfeeding. [1] If you have stopped breastfeeding, try to get help to re-establish breastfeeding. [5]

WHAT IS BABY IS ALSO HIV+

Remember that less than 1% of babies born to HIV positive mothers, become infected with HIV.

If an infant tests HIV-positive, there’s NO reason not to breastfeed. Breastfeeding is recommended for 2 years and longer.

 

Extended breastfeeding is better for an HIV-infected infant’s health, nutrition and survival. [4]

WHAT IF YOU CHOOSE NOT TO BREASTFEED?

If you are HIV-positive and choose not to breastfeed your baby after being counselled on infant feeding, make sure that you understand and get information on:

  • safer preparation and storage of formula

  • amounts and frequency of feeds

  • the cost of formula feeding 

  • the risks of not breastfeeding

 

REFERENCES

[1] PMTCT 2019 Guidelines South Africa - https://www.fidssa.co.za/Content/Documents/PMTCT_Guidelines.pdf

[2] Stats SA 2019 - http://www.statssa.gov.za/?s=HIV%2FAIDS+statistics

[3] WABA HIV Kit 2007 - https://waba.org.my/launch-of-the-waba-hiv-kit/

[4] WC HIV consolidated guidelines October 2018 - https://www.westerncape.gov.za/assets/departments/health/wc_hiv_consolidated_guidelines_march_2018_0.pdf

[5] Adult Primary care guidelines 2019 South Africa - https://www.knowledgehub.org.za/elibrary/adult-primary-care-apc-guide-20192020-updated

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