Feeding guidelines for infant born to HIV positive mother

Breastfeeding (BF) does carry a risk of transmission of HIV infection from HIV infected mothers to their infants. However, with use of maternal Anti Retro Viral (ARV) Drugs, the chances of HIV transmission to the foetus and the infant are greatly reduced as shown in table below.

Risk of HIV transmission from mother to child 

InterventionRisk of Transmission in BreastfeedingRisk of Transmission in NO Breastfeeding
No ARV30-45% 20-25%
Short course with 1 ARV 15-25% 5-15%
3 ARVs (ART)2% 1%

Every individual pregnant women should be informed about the alternative infant feeding options and their advantages and disadvantages as compared to breastfeeding. 

Exclusive Replacement Feeding (RF) is not a viable public health strategy in India and other developing nations for HIV exposed infants due to increased chances of non-HIV related morbidity and mortality negating the benefits of reduced HIV transmission. Thus, it cannot be recommended and promoted as the optimal infant feeding strategy for HIV-infected mothers in India. 

The current national guidelines for feeding of HIV-exposed and infants:

  • Exclusive Breast feeding for first 6 months of life is recommended. In a situation where the mother is practicing mixed feeding, Health-care workers and Counsellors should motivate her to exclusively breastfed. 
  • When exclusive breast feeding is not possible for any reason (maternal sickness, twins), Mothers and health care workers can be reassured that maternal ART reduces the risk of postnatal HIV transmission in the context of mixed feeding as well. 
  • Mothers known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status) should exclusively breastfeed their infants for the first six months of life, introducing appropriate complementary foods thereafter and continue breastfeeding.” 
  • “Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided.” Mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or beyond (similar to the general population) while being fully supported for ART adherence. 
  • Exclusive Replacement feeding may be considered only in situations where breastfeeding cannot be done or upon individual mother’s choice, only if all the 6 criteria for replacement feeding are met (CLICK for Criterias)

Thus, with ongoing maternal ART during pregnancy and lactation, there remains no difference in the feeding guidelines related to infant feeding of HIV exposed vs. unexposed infants. 

Post matter adapted from NACO guidelines, Click for Details.

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