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Region Hovedstaden - en del af Københavns Universitetshospital
E-pub ahead of print

Women Living with HIV in high-income settings and Breastfeeding

Publikation: Bidrag til tidsskriftReviewForskningpeer review

DOI

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Guidelines in high-income settings recommend breastfeeding avoidance among women living with HIV (WLWH). Increasingly WLWH in high-income settings, who are well-treated with fully suppressed viral loads, are choosing to breastfeed their infants, even with these recommendations. The purpose of this article is to review existing research and guidance on infant feeding among WLWH in high-income countries, and to identify gaps in this evidence that require further investigation. Current evidence on the risk of HIV transmission through breastfeeding in the context of antiretroviral therapy (ART), the significance of cell-associated virus, transmission risk factors, retention in care and adherence postpartum, infant prophylaxis and antiretroviral exposure, and monitoring of the breastfeeding WLWH are summarized. A latent HIV reservoir is persistently present in breastmilk, even in the context of ART. Thus, suppressive maternal ART significantly reduces, but does not eliminate, the risk of postnatal transmission of HIV. There are currently limited data to guide the optimal frequency of virologic monitoring and the clinical actions to take in case of maternal detectable viral load while breastfeeding. Moreover, retention in care and adherence to ART in the postpartum period may be difficult and more research is needed to understand what clinical and psychosocial support would benefit these mothers so that successful engagement in care can be achieved. The long-term effects of antiretroviral drug exposure in the infants also need further exploration. Thus, there is a need for collecting enhanced surveillance data on WLWH who breastfeed and their infants to augment clinical guidance in high-income settings.

OriginalsprogEngelsk
TidsskriftJournal of Internal Medicine
ISSN0954-6820
DOI
StatusE-pub ahead of print - 15 okt. 2019

Bibliografisk note

© 2019 The Association for the Publication of the Journal of Internal Medicine.

ID: 58140435