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
Very low
In settings where national or sub-national authorities have decided that maternal, newborn and child health services will principally promote and support breastfeeding and ARV interventions. Mothers known to be HIV-infected who decide to stop breastfeeding at any time should stop gradually within one month. Mothers or infants who have been receiving ARV prophylaxis should continue prophylaxis for one week after breastfeeding is fully stopped. Stopping breastfeeding abruptly is not advisable.
Notes and Remarks
- 1)The group noted that the overall quality of direct evidence informing this recommendation was very low (Grade profile 3, Annex 4). No research studies have ever been designed and implemented to compare the health outcomes of HIV-exposed infants following a longer or shorter period of breastfeeding cessation. However, research and programmatic experience, including reports from well-conducted qualitative studies and trials designed to investigate ART or other HIV-related interventions, were very consistent; namely, that rapid and abrupt cessation of breastfeeding was very difficult for mothers to achieve and was associated with adverse consequences for the infant, such as growth failure and increased prevalence of diarrhoea (6,9,14,18,30,36,37).
- 2)Breast-milk viral load is also known to spike with rapid cessation of breastfeeding and while this has not been shown to be associated with increased transmission or adverse outcomes in the infant, there is biological plausibility that this would be detrimental for the infant.
- 3)The group felt that WHO should make a recommendation, even if based on very little objective data, on the duration over which mothers should stop breastfeeding. This was considered better than making no statement and devolving this responsibility to health workers who would likely base their recommendations to mothers on very little evidence.
- 4)Evidence in support of the revised WHO recommendation that whichever ARV prophylaxis is provided to prevent HIV transmission through breastfeeding should continue for one week after all exposure to breast milk has ended is included in the WHO guidelines for the use of ARVs for treating pregnant women and preventing HIV infection in infants.