Breastfeeding in HIV - Importance and Effects

Introduction:

The human immunodeficiency virus (HIV) is transmitted from person to person through body fluids like blood, semen, rectal fluids, vaginal fluids, and breast milk. HIV infection is a contraindication for breastfeeding. However, it is recommended to breastfeed the child after the infected mothers are treated with anti-retroviral therapy. HIV is a sexually transmitted infection. There is no cure for HIV infection. This can spread from mother to child during childbirth or breastfeeding.

What Is the Importance of Breastmilk?

• The breastmilk supplies all the necessary nutrients in proper proportions.

• It shields the baby against allergies, sickness, and obesity.

• Breast milk provides essential antibodies. The colostrum (first breast milk) contains high immunoglobulin A antibodies.

• It shields against diseases like diabetes and cancer.

• Acts as a barrier against middle ear infections, respiratory tract infections, cold infections, and gut infections.

• Sudden infant death syndrome does not occur due to breastfeeding.

• Breast milk is easily digested.

• There is no constipation or diarrhea in the baby due to breastmilk consumption.

• The baby has a healthy weight.

• The risk of type two diabetes and certain cancers, such as breast cancer, is not developed in breastfeeding mothers.

What Are the Symptoms of HIV Transmission to the Baby?

• There are no symptoms of HIV infections, but it weakens the immune system.

• Lack of energy.

• Loss of weight.

• Frequent and long-lasting fever and sweats.

• Persistent yeast infections.

• Persistent skin rashes.

• Pelvic inflammatory disease (inflammation of fallopian tubes, uterus, vagina).

• Short-term memory loss.

• Frequent and severe herpes infection that causes mouth, genital or anal sores.

• Delayed physical and developmental growth.

• Swelling of abdomen.

• Oral thrush (a fungal infection in the mouth), the distinctive signs are white patches on the cheeks and tongue.

• Constant or recurring ear infections.

• Swelling of the lung.

• Hepatitis (inflammation of the liver cells).

• Kidney disease.

• Benign tumors.

• Malignant lesions.

How to Prevent HIV Transmission to the Baby?

• If the woman is pregnant or plans to conceive, get tested for HIV as soon as possible.

• The HIV test status is essential for proper management.

• If the result is HIV positive, then there is a need for immediate treatment for both mother and the child and to prevent transmission to the partner.

• If the HIV test result is negative, but there is a high chance of acquiring it, then get tested again in the third trimester (after six months).

• Encourage the partner to get himself tested for HIV.

Can HIV Medications Be Taken While Pregnant?

• Intake of HIV medications reduces the amount of HIV in the body. They reduce the viral load to a very low level, called viral suppression. If the viral load is so low that a lab test cannot detect it, this is called a not detectable viral load.

• Consumption of HIV medications and keeping an undetectable viral load is best to stay healthy and prevent transmission to the infant.

• Using HIV medications as prescribed throughout gestation and delivery can reduce the risk of HIV transmission.

• It is recommended to give HIV medication to the baby for four to six weeks after delivery to reduce the complications of HIV transmission.

• If the viral load is not reduced despite using HIV medications, proceed with cesarean delivery, which can help prevent HIV transmission.

• Breastfeeding is prohibited in HIV-positive mothers since there is a risk of transmitting HIV through breast milk even though the medications decrease viral load.

• Taking HIV medications also protects the HIV-negative partner.

Are HIV Medications Safe During Gestation?

Most HIV medications are safe to use during pregnancy. It is advisable to consult a physician and opt for a safer alternative to HIV medications.

What Are the Factors Associated With the Transfer of HIV Through Breast Milk?

• The maternal factors include the severity of HIV infection.

• The level of ribonucleic acid (RNA) viral load in the mother.

• Low level of CD4 (large glycoprotein associated with T lymphocytes) cell count.

• High level of CD8 (co-receptor of T cell receptor).

• Vitamin A deficiency.

• The virus in breast milk can transport as a cell-free or cell-associated virus.

What Are the Methods to Reduce HIV Transmission During Breastfeeding?

• Recommend using the antiretroviral drugs during gestation and also for lactating mothers.

• The first line of antiretroviral drugs is safe for pregnant and lactating women.

• There are more benefits than risks with the use of antiretroviral drugs.

• The medications are based on high genetic barriers, the method of suppressing viral replication, and the emergence of viral-resistant strains.

• Infant prevention is essential for the one exposed to viral load due to breastfeeding.

• Infants born to HIV-positive mothers are at a greater risk of developing the human immunodeficiency virus (HIV) infection and should receive Azidothymidine (AZT) and Nevirapine (NVP) for the first six weeks of life.

• The high-risk infants should continue the medications for 12 weeks after the post-delivery period.

• There is a need for viral load monitoring in pregnant women.

• Using expressed milk and practicing breast pumping when needed is necessary.

• Avoid breastfeeding in the first six months after delivery.

• Replace the breast milk with formulated milk which is given by bottle.

• The infants must not be offered solid food until they are six months old.

• The formulated milk is made from cow's milk that has been treated to make it more suitable for babies.

• The formulated milk is available in the form of dry powder mixed with boiled water and then cooled before feeding.

• Cleanliness and good hygiene are essential for formulated milk feeding.

• To avoid infection and contamination, use clean bottles for feeding.

• Sterilize the bottles with steam.

• The formulated milk is given in place of breast milk, which facilitates babies with the nutrients they require to grow and develop.

• The immune system of infants is not as strong as that of adults, so bacterial infection can occur by using bottles.

• However, the formulated milk cannot strengthen the baby's immune system.

• The formulated milk can reduce the risk of transmission of HIV through breast milk.

• Advise counseling to the mothers to avoid breastfeeding and also proper guidance regarding the risks.

Conclusion:

Since HIV transmission is through body fluids, breastfeeding is not advised in HIV-affected mothers. They cause severe complications to the newborn and oral lesions due to breastfeeding. Hence safer alternatives and proper medications are essential for the well being of the mother and the child.