HIV Prevention
Guidelines on HIV and infant feeding 2010
OVERVIEW
Significant programmatic experience and research evidence regarding HIV and infant feeding have accumulated since WHO's recommendations on infant feeding in the context of HIV were last revised in 2006. In particular, evidence has been reported that antiretroviral (ARV) interventions to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of postnatal transmission of HIV through breastfeeding. This evidence has major implications for how women living with HIV might feed their infants, and how health workers should counsel these mothers. Together, breastfeeding and ARV intervention have the potential to significantly improve infants' chances of surviving while remaining HIV uninfected.
While the 2010 recommendations are generally consistent with the previous guidance, they recognize the important impact of ARVs during the breastfeeding period, and recommend that national authorities in each country decide which infant feeding practice, i.e. breastfeeding with an ARV intervention to reduce transmission or avoidance of all breastfeeding, should be promoted and supported by their Maternal and Child Health services. This differs from the previous recommendations in which health workers were expected to individually counsel all HIV-infected mothers about the various infant feeding options, and it was then for mothers to decide between them.
Where national authorities promote breastfeeding and ARVs, mothers known to be HIV-infected are now recommended to breastfeed their infants until at least 12 months of age. The recommendation that replacement feeding should not be used unless it is acceptable, feasible, affordable, sustainable and safe (AFASS) remains, but the acronym is replaced by more common, everyday language and terms. Recognizing that ARVs will not be rolled out everywhere immediately, guidance is given on what to do in their absence.
These new guidelines as well as the annexes below are available in PDF.
ANNEXES
Annex 1 - Scoping questions for systematic reviews and issues to be addressed in revision of recommendations
Annex 2 - Protocol and summary of systematic review of HIV-free survival by infant feeding practices from birth to 18 months
Annex 3 - Search strategy for other scoping questions
Annex 4 - GRADE profiles
4a - Grade profiles 1-3. HIV-free survival by infant feeding practices 0-18m
4b - Grade profile 4. Nutritional adequacy of replacement feeds (excl. FF)
4c - Grade profile 5. Replacement feeds and survival vs. AFASS conditions
4d - Grade profile 6. Heat-treated breast milk
4e - Grade profile 7. Feeding HIV-infected infants
4f - Grade profile 8. Breastfeeding and maternal health
Annex 5 - Individual evidence summaries of all studies included in the systematic review of HIV-free survival by infant feeding practices from birth to 18 – 24 months
Annex 6 - Consolidated risk-benefit tables
Annex 7: Model to assess the impact of different infant feeding practices and antiretroviral interventions on infant HIV free survival
7a - PowerPoint presentation
7b - Assumptions
Annex 8 - PowerPoint presentation on costing model
Annex 9 - PowerPoint presentation on Individual Human Right within Public Health Approaches
Annex 10 - Declaration of interests forms
10a - Summary of declarations
10b - Declaration of interest forms
Attached resource:
