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United States Government updates Infant Feeding Guidelines for parents living with HIV (31/1/2023)

02/02/2023

The US Government has added updates to the section Infant Feeding for Individuals with HIV in the United States and now asserts the need for shared decision-making between providers and parents living with HIV and increased support from providers for parents’ infant-feeding choices.

The updates include the latest data on HIV and breastfeeding from resource rich countries. In the past, data on HIV transmission via breastfeeding has been from low and middle income countries. This latest data further supports the extremely low risk.

This update  to the guidelines from the US outlines: In five small case series that reported on breastfed infants in higher-resource countries, all mothers were on ART and almost all were virally suppressed. A group in Toronto described three breastfed infants with no transmission via breastfeeding.¹⁴ Nine women with 10 pregnancies successfully breastfed at one site in the United States,¹⁵ and eight women breastfed at a U.S. second site¹⁶; there were no cases of HIV transmission. Thirteen women, described in a prospective study conducted in Italy, also had no transmissions of HIV through breastfeeding.¹⁷ In Germany, among 30 women with HIV who breastfed, there were no cases of breastfeeding transmission of HIV, although only 25 women had optimal viral suppression. Four of the five women not considered to be optimally suppressed had viral loads of 50 to 70 copies/mL at some point postpartum, and two had had a detectable viral load early in pregnancy and, therefore, did not meet the authors’ criteria for optimal suppression.¹⁸ Of note, the approaches to infant prophylaxis ranged from 4 weeks of zidovudine (ZDV) to three-drug ARV regimens using therapeutic doses for the duration of breastfeeding.

READ the updated Infant Feeding for Individuals with HIV in the United States