Significance of Infant Feeding and Nutrition in an HIV-Positive Mother

Introduction

One of the most important decisions for new parents is selecting a feeding method for their children. This decision may become even more challenging when the child's mother has HIV. Since HIV (human immunodeficiency virus) can be transmitted from mothers to their children during pregnancy, labor, delivery, or breastfeeding, the prevention of mother-to-child transmission of HIV guidelines recommends alternative feeding where it is acceptable, feasible, affordable, sustainable, and safe. If this is unachievable, exclusive breastfeeding is recommended during the first six months of life.

What Are the Benefits of Breastfeeding?

Benefits for the Babies:

• Nutrition and Protection for Babies: Breast milk is the most nutrient-dense food for infants and young children. Additionally, it contains parental antibodies, which shield newborns from various diseases and allergies.

• Health Beyond Infancy: Breastfed babies have a decreased risk of developing diseases like obesity and type 2 diabetes in later life.

• Cost, Availability, and Convenience: Breast milk is free and readily available whenever the mother is with the baby. It can also be pumped and fed to the baby in a sterile bottle when the mother is not nearby.

Benefits for Breastfeeding Mothers:

• Bonding: Breastfeeding may help mothers feel closer to their infants.

• Mental Health: Breastfeeding also aids new mothers in preventing postpartum depression, which can be serious and make it difficult to care for a newborn.

• Maternal Blood Loss: Breastfeeding lowers the risk of blood loss after delivery.

• Overall Maternal Health: Breastfeeding reduces the risk of breast and ovarian cancers, high blood pressure, and diabetes.

What Is the Possibility of Passing HIV to Your Infant While Feeding?

According to studies, the risk of transmission is significantly lower for mothers who receive HIV treatment throughout the breastfeeding period. Furthermore, a greater risk of transmission was linked to higher viral loads.

• When the Mother Is on Treatment and Well Adherent to the Treatment: The risk of transmission during breastfeeding is low. However, it depends on the viral load, the mother's state of health, the baby's health, and the period of breastfeeding the infant.

• When Both the Mother and the Child Are Not on HIV Treatment: There is a 20 % chance of the child getting HIV after more than two years of breastfeeding. In the absence of treatment, providing solid foods, formula feed, or water in addition to breast milk does not reduce the risk but increases the likelihood of HIV transmission.

• When the Mother Uses Formula Feeding: The risk of transmission during breastfeeding is zero if the feeding practice is safe and sterile.

More study is required to determine the length of treatment before breastfeeding and the impact of adherence and viral load on the transmission.

What Are the Factors to Be Considered Before Breastfeeding?

Factors involving the safety of breastfeeding with HIV include:

• Antiretroviral Therapy (ART): To lessen the chance of transmission, mothers with HIV should consistently receive antiretroviral therapy throughout their pregnancy and while breastfeeding.

• Maternal Virus Count: Breastfeeding may be safer for HIV-positive mothers with undetectable viral loads.

• Other Available Feeding Resources: Access to affordable, clean water, formula milk, or donor milk will influence the options for feeding a newborn.

What Does the World Health Organization (WHO) Recommend?

• World Health Organization (WHO) recommends all mothers with HIV should receive life-long antiretroviral therapy. If they are adherent to therapy, they can exclusively breastfeed their infants for the first six months and then continue with the addition of solid food until 12 months.

• Breastfeeding with additional feeding may continue until 24 months of age or beyond.

• This new guidance is based on scientific evidence that ART (anti-retroviral therapy) prevents transmission of HIV through breastfeeding as long as the mother sticks to therapy.

• It also recommends four to six weeks of antiretroviral prophylaxis for the baby after birth. The baby should also be frequently tested for HIV at least three months after weaning.

Why Are the WHO Recommendations Different From Other Organizations?

• WHO has adjusted its recommendations based on ART treatment. However, other organizations like the Center for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend using safe formula feeding over breastfeeding regardless of ART treatment and viral load suppression.

What Are the Other Baby-Feeding Options Available for HIV-Positive Mothers?

Donor milk and formula can be other feeding options for a person with HIV if they choose not to breastfeed or are advised not to breastfeed.

• Donor Milk:

  • Breast milk can be donated by lactating women who have extra to the donor milk banks, where it will be screened and given to the babies of HIV-positive mothers.

• Formula Feeding:

  • Formula milk is a breast milk alternative that provides babies with the nutrients they need to grow and develop during the first six months of their life.

  • Commercial infant formula milk provides infants with the best nutrients but is expensive.

  • The home-prepared formula is made with fresh animal milk, dried whole milk, or unsweetened evaporated milk. These kinds of milk can be modified to make them suitable for infants by adding micronutrients and sometimes vitamin A and folic acid.

What Are the Disadvantages of the Alternatives?

• Due to donor milk's high cost, some people accept extra breast milk from friends or family. However, since this milk is not screened, participating in these exchanges is not generally advised.

• Formula feeding always has the risk of diarrhea and vomiting if there is no reliable access to clean drinking water and sterilization.

• Formula feed will not strengthen the baby's immune system as breast milk.

• A considerable expense is associated with formula feeding, including purchasing sterilizing equipment and bottles.

What Should Be Done if an HIV-Positive Mother Chooses to Breastfeed?

• The HIV-positive mother should continue to take HIV treatment and maintain an undetectable viral load.

• Monthly check-ups at the HIV clinic should be done with the baby during breastfeeding and for two months afterward.

• Both the mother and the baby should be free from stomach problems. Because if the mother has a stomach upset, she may not absorb the HIV medication properly, and if the baby has a stomach upset, HIV may be more likely to enter the bloodstream.

• The breasts and nipples of the mother should be healthy with no signs of infection.

• Breastmilk can be frozen and stored in a sterile container to use in case of stomach problems or an infection of the mother.

• However, a supply of formula milk, bottles, and sterilizing equipment should be available at home in an emergency.

Conclusion:

HIV-positive mothers may find it challenging to decide how to feed their infants. Regarding the safety of breastfeeding while living with HIV, there is no definitive answer. According to WHO recommendations, health systems must develop high-quality HIV services that consistently deliver ART and care for HIV-positive mothers. To encourage a good environment for women living with HIV to stick to ART treatment, governments and local authorities should aggressively help further and implement programs.