In the Journals

AAP: Mothers with HIV should avoid breast-feeding

A policy statement issued today by the AAP’s Committee on Pediatric AIDS recommends that American mothers who are infected with HIV should not breast-feed their infants, regardless of whether they are on antiretroviral therapy.

The only way to completely prevent HIV transmission through human milk is not to breast-feed, according to the policy statement published recently in Pediatrics.

The statement differs from WHO recommendations in developing countries, where infant formula feeding typically isn’t feasible and malnutrition and infectious disease are bigger threats. In this setting, breast-feeding is recommended in combination with antiretroviral drug administration to the infant or the mother. Antiretroviral drugs have been shown to reduce the risk of breast-milk transmission from mother to infant, but not eliminate it, with a residual risk of breast-milk transmission 1% to 5% at 6 months.

In the United States, where safe alternatives to breast milk such as infant formula and clean water are readily available, the risk of HIV transmission through breast-feeding outweighs the potential benefits of breast milk, according to the statement.

Although a low risk, “transmission can occur despite undetectable maternal plasma RNA concentrations,” Lynne M. Mofenson, MD, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, told Infectious Diseases in Children.

The researchers urge pediatricians to help mothers find financial support if budgetary constraints are identified “as a barrier to avoiding breast-feeding.” The researchers also recommend application to the Special Supplemental Nutrition Program for Women, Infants, and Children.

The statement goes on to discourage mothers with HIV to avoid other risky practices for transmission, such as pre-chewing food.

Finally, the statement reinforces an earlier AAP recommendation for exclusive breast-feeding for mothers who do not have HIV.

Disclosure: Mofenson reports no relevant financial disclosures.

Lynne M. Mofenson, MD, can be reached at 6100 Executive Boulevard, Room 4B11, Rockville, MD 20852; email: LM65D@nih.gov.

A policy statement issued today by the AAP’s Committee on Pediatric AIDS recommends that American mothers who are infected with HIV should not breast-feed their infants, regardless of whether they are on antiretroviral therapy.

The only way to completely prevent HIV transmission through human milk is not to breast-feed, according to the policy statement published recently in Pediatrics.

The statement differs from WHO recommendations in developing countries, where infant formula feeding typically isn’t feasible and malnutrition and infectious disease are bigger threats. In this setting, breast-feeding is recommended in combination with antiretroviral drug administration to the infant or the mother. Antiretroviral drugs have been shown to reduce the risk of breast-milk transmission from mother to infant, but not eliminate it, with a residual risk of breast-milk transmission 1% to 5% at 6 months.

In the United States, where safe alternatives to breast milk such as infant formula and clean water are readily available, the risk of HIV transmission through breast-feeding outweighs the potential benefits of breast milk, according to the statement.

Although a low risk, “transmission can occur despite undetectable maternal plasma RNA concentrations,” Lynne M. Mofenson, MD, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, told Infectious Diseases in Children.

The researchers urge pediatricians to help mothers find financial support if budgetary constraints are identified “as a barrier to avoiding breast-feeding.” The researchers also recommend application to the Special Supplemental Nutrition Program for Women, Infants, and Children.

The statement goes on to discourage mothers with HIV to avoid other risky practices for transmission, such as pre-chewing food.

Finally, the statement reinforces an earlier AAP recommendation for exclusive breast-feeding for mothers who do not have HIV.

Disclosure: Mofenson reports no relevant financial disclosures.

Lynne M. Mofenson, MD, can be reached at 6100 Executive Boulevard, Room 4B11, Rockville, MD 20852; email: LM65D@nih.gov.