HIV&lactation and the States

[nsnvbella]

hi, i'm a nursing student currently doing my bsn. first off i want to thank anyone who chooses to respond. this posting is part of an assignment for class and your input would be greatly valued.

hiv and lactation

the who recently published a research study (bull world health organ. 2005 jun;83(6):418-26. epub 2005 jun 17) that determined the association of different feeding patterns for infants with hiv infected mothers, with mortality and hospital admissions. the study used populations from three developing countries (ghana, india and peru) and showed that in the 9424 infants monitored mortality was higher in those who did not breastfeed than those who did (predominantly breastfed and exclusively breastfed). death in non breastfed infants were mostly related to acute lower respiratory infections and diarrhea.

as i have learned in class (and from dr green http://www.drgreene.com/21_552.html) breastfeeding is far superior to any other means of infant feeding. due to that fact that its composition includes immunoglobins, lactoferrin (which have an antibiotic effect on bacteria such as staph and e.coli), lysoszyme, growth factors, allergic factors, carnatine, and dha & aha, in relation to formula there is no comparison.

the american academy of pediatrics stated in their policy concerning breast milk that they have found it to reduce the incidence and/or severity of diseases such as diarrhea, lower respiratory infections, ear infections, bacterial meningitis, and urinary tract infections. (american academy of pediatrics work group on breastfeeding, pediatrics 100:1035-1039, 1997)].

as searching previous posts from lactnet as well as searching pubmed i found many entries on breastfeeding and hiv in developing countries but not many specific to the states. my question is what are the current practices concerning lactation and the hiv infected mother here in the states (for nurses, midwifes as well as nurse practitioners) and/or what have you personally experienced or seen in the clinical setting concerning this subject?

once again thank you for your input.

isabella, rn to be.

[bahamabread]

firstly......hiv is transmitted in breastmilk. so it is not advised...........

you may say that the infant has hiv anyway.........but that cant be absolutely determined until the child is 18 months old ( the baby will test positive before this time regardless due to the mothers antibodies still in the infants circulation)

now,,,,,,in some countries where alternate feeding for the infant can not be afforded............breast milk may be understandable...............the child has to be fed and the milk is good except that it may transmit hiv,,,,,,,but its done everyday and the women have no choice.

in my country the hiv rate is very high but we give medication to all hiv positive women during pregnancy,,( and we test every pregnant woman),,,,,,,,,and it is very effective. i have seen babies after 18 months who are negative.........many babies!!!!!!!

so we definately dont allow the women to breastfeed!!!!!!!!!!! we make it very understood why they cant...........and they do well.

[VickyRN, MSN, DNP, RN]

the current recommendation in the united states is that breastfeeding is contraindicated in women who are hiv positive.

although breastfeeding is optimal for infants, there are a few conditions under which breastfeeding may not be in the best interest of the infant. breastfeeding is contraindicated in infants with classic galactosemia (galactose 1-phosphate uridyltransferase deficiency)103; mothers who have active untreated tuberculosis disease or are human t-cell lymphotropic virus type i-or ii-positive104,105; mothers who are receiving diagnostic or therapeutic radioactive isotopes or have had exposure to radioactive materials (for as long as there is radioactivity in the milk)106-108; mothers who are receiving antimetabolites or chemotherapeutic agents or a small number of other medications until they clear the milk109,110; mothers who are using drugs of abuse ("street drugs"); and mothers who have herpes simplex lesions on a breast (infant may feed from other breast if clear of lesions). appropriate information about infection-control measures should be provided to mothers with infectious diseases.111

in the united states, mothers who are infected with human immunodeficiency virus (hiv) have been advised not to breastfeed their infants.112 in developing areas of the world with populations at increased risk of other infectious diseases and nutritional deficiencies resulting in increased infant death rates, the mortality risks associated with artificial feeding may outweigh the possible risks of acquiring hiv infection.113,114 one study in africa detailed in 2 reports115,116 found that exclusive breastfeeding for the first 3 to 6 months after birth by hiv-infected mothers did not increase the risk of hiv transmission to the infant, whereas infants who received mixed feedings (breastfeeding with other foods or milks) had a higher rate of hiv infection compared with infants who were exclusively formula-fed. women in the united states who are hiv-positive should not breastfeed their offspring. additional studies are needed before considering a change from current policy recommendations.

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496

• of seven children born to an hiv-sero-positive mother: one will be infected through breastfeeding, two to three will be infected through in-utero or intra-partum transmission, and three to four will remain uninfected (whether or not the mother is breastfeeding) (devincenzi, 1997).
  
• an estimated one-third to one-half of all mother-to-child transmission of hiv worldwide (kreiss, 1997) and in africa (ekpini et al, 1997; simonon et al, 1994) is due to breastfeeding.
  
• fourteen percent of children who are breastfed by a mother who was infected before delivery and 29 percent of children who are breastfed by a mother who was infected after delivery will become hiv-infected through breastfeeding (dunn et al, 1992).
  

http://sara.aed.org/publications/cross_cutting/hiv_infant/html/infant.htm