Bibliographic Info
GuidelineGuidelines on HIV and infant feeding 2010: principles and recommendations for infant feeding in the context of HIV and a summary of evidence
Year of Publication2010
Issuing InstitutionWHO
Recommendation
Status
Updated
Recommended in favor
Strong
Certainty of evidence
Moderate
If infants and young children are known to be HIV-infected, mothers are strongly encouraged to exclusively breastfeed for the first six months of life and continue breastfeeding as per the recommendations for the general population, that is, up to two years or beyond.
Notes and Remarks
- 1)This same recommendation appeared in the 2006 WHO recommendations on HIV and Infant Feeding. (See Grade profile 7, Annex 4.)
- 2)The systematic review (Annex 5) identified reports from two studies that were not included in the review that supported the earlier recommendation and that directly reported on the mortality of HIV-infected infants according to their early feeding practices:
- 3)In a randomized controlled trial in Zambia in which infants of HIV-infected breastfeeding mothers either stopped all breastfeeding at 4 months of age or continued to breastfeed, among infants who were already HIV-infected mortality at 24 months was 55% among those randomized to continued breastfeeding compared to 74% among those who stopped breastfeeding early (18).
- 4)In a study in Botswana that randomized HIV-exposed infants to either breastfeed or receive infant formula, among infants who were already HIV-infected, mortality at 6 months of age was 7.5% in those who breastfed compared to 33% in those randomized to receive infant formula only.
- 5)The group concluded that there was a clear benefit for continued breastfeeding (47).
- 6)Additional studies reported morbidity outcomes such as increased diarrhoea and malnutrition, and the group considered that these supported the mortality evidence that continued breastfeeding is beneficial to the infant who is already HIV-infected