New WHO guidelines on HIV and infant feeding
There has been significant programmatic experience and research on HIV and infant feeding since the World Health Organisation's (WHO) recommendations on infant feeding in the context of HIV were last revised in 2006. In particular, evidence has been reported that antiretroviral (ARV) interventions to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of postnatal transmission of HIV through breastfeeding. This evidence has major implications for how women living with HIV might feed their infants, and how health workers should counsel these mothers. Together, breastfeeding and ARV intervention have the potential to significantly improve infants' chances of surviving while remaining HIV uninfected. This evidence informs the recently released 'Guidelines on infant feeding and HIV, 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence.' The guidance emphasises that HIV-free child survival - rather than HIV transmission - is the primary consideration.
While the 2010 recommendations are generally consistent with the previous guidance, they recognise the important impact of ARVs during the breastfeeding period. They recommend that national authorities in each country decide which infant feeding practice, i.e. breastfeeding with an ARV intervention to reduce transmission or avoidance of all breastfeeding, should be promoted at national and sub-national levels. This differs from the previous recommendations in which health workers were expected to individually counsel all HIV-infected mothers about the various infant feeding options.
The recommendation that replacement feeding should not be used unless it is acceptable, feasible, affordable, sustainable and safe (AFASS) remains, but the acronym is replaced by more common, everyday language and terms.
Where national authorities promote breastfeeding and ARVs, mothers known to be HIV-infected are now recommended to breastfeed their infants until at least 12 months of age. If social and environmental conditions are not in place for safe replacement feeding at this stage, breastfeeding should continue in line with recommendations for the general population.
Recognising that ARVs will not be rolled out everywhere immediately, guidance is given on what to do in their absence. When ARVs are not available, mothers should be counselled to exclusively breastfeed in the first six months of life and continue breastfeeding thereafter unless environmental and social circumstances are safe for, and supportive of, replacement feeding. In circumstances where ARVs are unlikely to be available, such as acute emergencies, breastfeeding of HIV-exposed infants is also recommended to increase survival.
Download the 2010 guidance, including supporting annexes, evidence and presentations at: http://www.who.int/child_adolescent_health/documents/9789241599535/en/index.html
More like this
en-net: Should you recommend wet nursing in HIV prevalent areas where replacement feeding is not safe but there is no HIV testing available?
Current WHO guidance on infant feeding and HIV (2010) emphasises a public health approach to infant feeding choice in the HIV context. It emphasises that feeding...
FEX: Counselling on infant feeding choice: Some practical realities from South Africa
By Tanya Doherty (pictured), Mickey Chopra and Mike Colvin Tanya is currently a senior scientist at the Health Systems Trust and Medical Research Council in Capetown, South...
FEX: Adequacy of Replacement Milks for Infants of HIV-Infected Mothers
Summary of published research1 Feeding recommendations for infants of infected HIV-mothers in developing countries remain controversial. As HIV can be transmitted to the infant...
FEX: Diarrhoea risk associated with not breastfeeding in Botswana
Summary of report and presentation1 Between November 2005 and February 2006, there were unusually heavy rains and flooding in Botswana, and by January 2006, there was an...
en-net: Infant feeding and Ebola Outbreak
Posted on behalf of Fabienne Rousseau, ACF I have a question related to infant feeding in the context of the Ebola outbreak in West Africa. Our teams are engaged in...
FEX: Infant Feeding Alternatives for HIV Positive Mothers in Kenya
By Tom Oguta, Abiud Omwega and Jaswant Sehmi Tom Oguta is currently a PhD student of Nutrition at the University of Nairobi. He has worked as a Research Officer at KIRDI...
FEX: Cotrimoxazole as a Prophylaxis for HIV Positive Malnourished Children
Summary of review1 By Susan Thurstans, AAH Susan Thurstans is the HIV adviser with Action Against Hunger (AAH), based in Malawi Thanks to Amador Gomez, Technical Advisor,...
FEX: Appropriateness of Replacement Milks in South Africa
Summary of published paper1 Feeding recommendations for infants of HIV-infected mothers in developing countries remain controversial. The World Health Organisation (WHO)...
FEX: Infant Feeding Patterns and Risk of Death
Summary of published paper1 Current WHO guidelines recommend that HIV positive mothers should avoid breastfeeding only if replacement feeding is acceptable, feasible,...
FEX: Infant feeding and HIV transmission
Summary of Published paper The observation that mother-to-child transmission by HIV-1 infected women can occur through breastfeeding has resulted in policies that recommend...
FEX: Integrated PMTCT Services in a Rural Setting in Malawi
By Gertrude Kara, WFP and Mary Corbett, ENN Gertrude Kara is the Programme Officer responsible for HIV/AIDS programmes in WFP Malawi. She has wide experience in the area of...
en-net: IYCF-E and Covid 19: questions from the field
Dear all, in support to the initial exercise supported by Mija, Save the Children is engaging country offices to understand what are the questions and concerns around...
FEX: Using IMRs to inform policy decisions on infant feeding and HIV
Summary of published research1 Feeding bottles in a camp in Pakistan A recently published paper presents an analysis of the impact of WHO infant feeding recommendations in...
en-net: COVID-19 and Safety of Breast Milk and/or Breastfeeding -Please send all your questions
Dear colleagues Gradually I am getting more questions on the safety of breast milk, breastfeeding etc. in the context of COVID-19. I know that you as health/nutrition...
FEX: Better Practice in Targeted Food Assistance
Summary of published report1 C-Safe, a consortium of non-governmental organisations (NGOs) for the southern Africa food security emergency, has recently completed its second...
en-net: Safe alternatives to breast milk in rural sub-Saharan Africa that are not formula milk?
In South Sudan, many women report not being able to breastfeed. Whilst in some cases this is about traditional beliefs and practices around infant feeding, maternal nutrition...
FEX: Effect of Breastfeeding and Formula Feeding on Transmission of HIV-1
Summary of published clinical trial Transmission of human immunodeficiency virus type 1 (HIV-1) is known to occur through breastfeeding, but the magnitude of risk has not been...
FEX: Infant feeding strategies and PMTCT - Mashi trial from Botswana
Summary of published research1 Arecently published paper compares the efficacy and safety of two infant feeding strategies for the prevention of postnatal mother-to-child HIV...
FEX: WHO Technical Consultation and Update on HIV and Infant Feeding
The Report of a Technical Consultation on Prevention of HIV Infections in Pregnant Women, Mothers and their Infants and Infant Feeding and an Update of recommendations1 is now...
FEX: Lipid-Based Nutrient Supplement Research Network Meeting
By Sarah Style Sarah Style is part of the ENN team working with UNHCR on the Anaemia Control, Prevention and Reduction Project In April 2011, the International Lipid-Based...
Reference this page
New WHO guidelines on HIV and infant feeding. Field Exchange 39, September 2010. p29. www.ennonline.net/fex/39/new
(ENN_4051)