The U.S. Pediatric Association has approved breastfeeding for HIV-positive people

People with HIV can breastfeed their babies if they take drugs that effectively suppress the virus that causes AIDS, a leading U.S. pediatric organization said Monday in a sweeping policy change.

A new report from the American Academy of Pediatrics (AAP) reverses recommendations that have been in place since the start of the HIV epidemic in the 1980s.

It notes that regularly prescribed drugs can reduce the risk of transmitting HIV through breast milk to less than 1%, said Dr. Lisa Abuogi, a pediatric HIV expert at the University of Colorado and lead author of the report.

"Medications are now so effective and the benefits to mother and baby are so great that it is important to make decisions together," Abuogi said.

Antiretroviral therapy (ART) does not eliminate all risk of HIV transmission through breast milk. The only reliable way to prevent the spread of the virus is to avoid breastfeeding, Abuogi said.

Additionally, parents should exclusively breastfeed their baby for the first six months, as research shows that switching between breast milk and formula can disrupt the baby's gut flora, increasing the risk of HIV infection.

In the United States, about 5,000 people with HIV are born each year. Almost all of them take drugs to suppress the virus to very low levels, Abuogi said, although the virus can rise if the drug regimen is not followed.

Before the drugs became widely available about a decade ago, about 30% of HIV transmissions from mothers to babies occurred during breastfeeding, said Dr. Lynn Moffensohn, a consultant with the Elizabeth Glaser Pediatric AIDS Foundation. In the early 1990s, about 2,000 infants were infected each year in the United States. Today, there are fewer than 30.

The AAP policy change comes more than a year after the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) rescinded long-standing recommendations against breastfeeding for people with HIV. Those recommendations say that people with persistent viral suppression should be counseled about their options. They also emphasize that health care providers should not notify child protective services if a parent with HIV wants to breastfeed.

The goal is to listen to patients "and not blame or shame them," said Dr. Lynn Yee, a professor of obstetrics and gynecology at Northwestern University who helped develop the NIH guidelines.

Breastfeeding provides ideal nutrition for babies and protects them from diseases and conditions such as obesity and type 2 diabetes, research shows. Breastfeeding also reduces the risk of breast and ovarian cancer, diabetes and high blood pressure in the mother.

Since 2010, the World Health Organization (WHO) has recommended that women living with HIV in developing countries breastfeed their infants and have access to antiretroviral therapy. The guidance took into account the risk of HIV infection through breastfeeding and the risk of infant death from malnutrition, diarrhea, and pneumonia in settings where safe breast milk substitutes are not available.

However, in developed countries, experts have recommended avoiding breastfeeding because of the widespread availability of safe water, formula and donor breast milk, which could eliminate the risk of HIV transmission, Yee said.

This was frustrating for people with HIV, who were flatly denied the opportunity to breastfeed.

CC Covin, 36, of Philadelphia, said she was diagnosed with HIV at age 20 and was not allowed to breastfeed her first child, Zion, now 13.

"I couldn't understand why my sister, who lives in Kenya and looks just like me, has the same skin colour, was allowed to breastfeed, but I was absolutely refused," she said.

The inability to breastfeed her son led to postpartum depression for Covin, she said. When she became pregnant with her now 2-year-old daughter, Zuri, her medical team helped her successfully breastfeed for seven months. Covin took her medications as prescribed and also gave her baby medications to prevent infection.

" Breast milk contains everything my baby needs," Covin said. "It's a wonderful thing."

Abuogi said the AAP report provides important recommendations for pediatricians, nurses and lactation consultants who work directly with children and families.

Some health workers were already helping people being treated for HIV breastfeed their babies, despite previous recommendations. The new guidelines should expand the practice, hoping for rapid adoption, Abuogi said.

"This is a unique situation because it's not just doctors and health care providers that are changing," Abuogi said. "Our patients are driving that change, too."