Pregnant women who regularly receive Anti Retroviral Therapy(ART) before delivery are expected to have a low number of HIV copies in their blood and pose a negligible risk of transmission of the virus during labour and delivery, so that they may have a normal vaginal birth and might also eventually breastfeed. World Health Organization (WHO) also recommends that in its Guidelines
With both on ART i.e. Maternal ART with 2 drugs and infant nevirapine prophylaxis, the postnatal-mother-to-child transmission rate while doing exclusive breastfeeding in first 6 months are less than 2%(reported as 0.5% to 3 %in different studies), which is much less as compared to risk of transmission during pregnancy or during a caesarean or a vaginal birth.
Based on WHO and NACO guidelines, Indian Academy of Pediatrics also issued guidelines for feeding of the Infant of HIV positive mothers in 2018, which are in place till date-
Summary of IAP Feeding Guidelines for HIV +ve Mothers
- Every Mother/Family should be counselled for an Exclusive Breastfeeding after educating them with minimal risks of transmission of HIV and about risks of Not Breastfeeding.
- Mothers who insist on not breastfeeding and opt for exclusive replacement feeding (ERF) should be explained that they are doing so at their own risk and this is contrary to the WHO/ NACO’s guidelines of giving exclusive breastfeeds.
- Also, Feasibility of a Safe Alternative replacement feeding should be discussed and this alternative should fulfil the AFASS criteria*
- 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.
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.