by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

December 14, 2021

Featured Literature:

Yusuf HE, Knott-Grasso MA, Anderson J, et. al. Experience and outcomes of breastfed infants of women living with HIV in the United States: findings from a single-center breastfeeding support initiative. J Pediatric Infect Dis Soc. 2021 Dec 9; piab116. doi:10.1093/jpids/piab116. Online ahead of print.

This article describes ARV approaches to, and outcomes among, ten infants who were exclusively breastfed by nine mothers living with HIV and receiving care at a single U.S. urban health center. The center offered a multi-disciplinary support program to assist women with HIV who desired to breastfeed and met pre-established criteria (namely, adherence to care and ART, and sustained virologic suppression). Reasons for choosing to breastfeed included: concerns for infant health, disclosure concerns, cultural expectations, and religious beliefs. Eight women were non-native immigrants from low/middle-income countries in Africa, and four had previously delivered and nursed infants while living with HIV. Infants were initiated on a combination of zidovudine, lamivudine, and nevirapine for 4-6 weeks, followed by NVP alone continued through 6 weeks after breastfeeding discontinuation; mean duration of breastfeeding: 4.4 months. Mother-infant dyads were seen at monthly visits during which breastfeeding and ART adherence were assessed and supported, HIV PCR testing was pursued, and further counseling was provided e.g., guidance for weaning. Infant HIV RNA was measured at 2-8 week intervals (depending on age, breastfeeding status, timing relative to NVP/breastfeeding cessation). All infant had negative viral RNA PCR measurements at a median age of 16 months.

Author’s Commentary:

This is the first U.S.-based report of breastfeeding outcomes of women living with HIV receiving comprehensive, multi-disciplinary care through a dedicated breastfeeding support program. Although participants may not be representative of the overall population of pregnant/parenting people with HIV in the U.S. (i.e., some women in this program had prior experience breastfeeding while living with HIV, and all were virologically suppressed on ARVs prior to conception or delivery), this program description and evaluation adds evidence to, and helps advance conversations around, the topic of breastfeeding and HIV in the U.S. Of note, no perinatal/postnatal transmissions were observed. Additional details such as infant clinical and laboratory monitoring practices and findings may also help address questions and/or concerns about optimal ARV prophylaxis approaches for breastfeeding infants.

The author has no conflicts of interest to disclose.

View archived Clinical Research Update entries here.