The transmission of HIV from mother to child is a standing risk during pregnancy, childbirth or breast feeding. This is also called perinatal transmission of HIV.
That does not mean that every baby born to a HIV positive woman contracts the virus. In the contrary, the risk of transmission can be as low as two percent depending on the time of detection.
Early detection of HIV during pregnancy or before pregnancy allows the mother and the care giver to adopt strategies and medication that lowers the risk of transmission. Certain cases require a caesarean delivery. Babies of mothers with HIV receive medication for 4 to 6 weeks after they are born. This medication reduces the risk of infection from any HIV that may have entered the baby during childbirth.
Breast milk, like all other body fluids contains the virus in HIV positive mothers. The U.S. perinatal guidelines prohibit HIV positive mothers from breastfeeding babies. Instead, it is advised to switch to a baby formula or banked breast milk. In the absence of antiretroviral therapy (ART) the babies are 16% susceptible to contracting the virus from their mothers. In most cases even though the therapy is administered on both the mother and the child, the risk of transmission ranges from 1.1 to 5.5%.
However, on November 2009, WHO for the first time recommended infant feeding by HIV-positive mothers. They recommended antiretroviral drugs to HIV-positive mothers or their infants throughout the period of breastfeeding and until the infant is 12 months old. As a result the infants can be benefited from breastfeeding with very little risk of becoming infected with HIV.
It is well known that breastfeeding provides the best source of nutrition to newborns. However, the lack of widespread awareness and stigma around AIDS, health workers are often faced with challenges when it comes to HIV Positive mothers breastfeeding their children.
Only information and awareness is insufficient as mothers resort to covert breastfeeding their children once out of the clinician’s eyesight. Their maternal instincts lead them to giving a mixed diet of breast milk and baby formula, which could eventually prove fatal.
As suggested by certain theories, mixed feeding exposes your baby to higher risks of transmission. While the formula is known to irritate the gut of the baby, the ingestion of the breast milk containing HIV provides the virus a getaway into the baby’s system.
However for a mother, the hardest part is adjusting to this new lifestyle, often an emotionally draining factor. There are situations where the mother has no other alternative to breastfeeding. As pointed out on the Bulletin of the WHO, in African countries where the economy is not enough to avail baby formulas, health care providers have to take the harm reduction approach.
Besides adequate support, education and empowerment, there are medications and therapies to be administered to reduce risks of transmission. Ensuring the mothers are virally suppressed for the duration is one of the key requirements. The breastfed babies are on ARV prophylaxis beyond the standard 6 week duration and quantification of viral loads are carried out at regular intervals.
Mothers are asked to report signs of mastitis and also tested for the viral loads regularly, even after weaning.
There is a lot for us to learn about the associated risks of HIV positive mothers breastfeeding, even If they are on therapy to suppress viral load. Until then, the mothers and health care providers are to maintain harmony while deciding what is best for the baby.