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
Conditional
Certainty of evidence
Very low
Mothers known to be HIV-infected may consider expressing and heat-treating breast milk as an interim feeding strategy: in special circumstances such as when the infant is born with low birth weight or is otherwise ill in the neonatal period and unable to breastfeed; or when the mother is unwell and temporarily unable to breastfeed or has a temporary breast health problem such as mastitis; or to assist mothers to stop breastfeeding; or if antiretroviral drugs are temporarily not available
Notes and Remarks
- 1)Laboratory evidence demonstrates that heat treatment of expressed breast milk from HIV-infected mothers, if correctly done, inactivates HIV (42–44). Several different methods of heat treatment have been tested in a range of controlled and ‘real life’ conditions. Furthermore, the methods of heat treatment do not appear to significantly alter the nutritional or immunological composition of breast milk (43,45,46). Breast milk treated in this way should be nutritionally adequate to support normal growth and development. For these reasons, heat treatment of expressed breast milk from mothers known to be HIV-infected could be considered as a potential approach to safely providing breast milk to their exposed infants. (See Grade profile 6, Annex 4.)
- 2)However, the group noted the paucity of programmatic data that demonstrate its acceptability and sustainability at scale as an infant feeding strategy to improve HIVfree survival. While reports are beginning to emerge describing its use in neonatal units or as a short-term approach in specific communities, the group was not confident to recommend this approach for all HIV-infected mothers who wish to breastfeed. More data is needed from a range of settings to understand what is required from health systems to effectively support mothers in this approach, and evidence is also needed to demonstrate that mothers can sustain adhering to the method over prolonged periods of time. Given the efficacy of ARVs to prevent HIV transmission through breastfeeding, the role of heat treatment of expressed breast milk as a truly feasible HIV prevention and child survival strategy is yet to be clarified. Until then, the group positioned the approach as an ‘interim’ strategy to assist mothers over specific periods of time rather than for the full duration of breastfeeding.
- 3)The group endorsed the need for continued research in this area of HIV prevention and child survival.