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Review article: Biomedical intelligence

Vol. 148 No. 2930 (2018)

Is breastfeeding an equipoise option in effectively treated HIV-infected mothers in a high-income setting?

DOI
https://doi.org/10.4414/smw.2018.14648
Cite this as:
Swiss Med Wkly. 2018;148:w14648
Published
24.07.2018

Summary

Combined antiretroviral treatment (cART) has reduced mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) to virtually zero in industrialised countries, where strictly bottle feeding is recommended for HIV-infected mothers, and to as low as 0.7% after 12 months in low-resource settings, where breastfeeding is strongly encouraged. Given the theoretically very low risk of transmission by breastfeeding with cART, and the advantages and benefits of breastfeeding, also in industrialised countries, the strong recommendation to HIV-infected mothers to refrain from breastfeeding in this setting may no longer be justified.

We have evaluated risks of breastfeeding for HIV MTCT in the light of accessible cART, the general benefits of breastfeeding, and the women's autonomy to consent to any intervention. As we found no evidence in the literature of HIV MTCT via breastfeeding whilst on effective cART, we identified a situation of clinical equipoise.

We propose how to proceed in Switzerland when HIV-infected women consider breastfeeding. We advocate a shared decision-making process and suggest a list of topics on which to provide unbiased information for the HIV-infected mother to enable her comprehensive understanding of one or the other decision.

Although breastfeeding still should not be actively recommended in Switzerland, any HIV-infected mother, regardless of her geographical and cultural background, who decides to breastfeed should be supported by the best strategy to achieve optimal medical care for both herself and her child. This includes continuous support of cART adherence and regular maternal HIV plasma viral load monitoring.

References

  1. Luzuriaga K, Mofenson LM. Challenges in the Elimination of Pediatric HIV-1 Infection. N Engl J Med. 2016;374(8):761–70. doi:.https://doi.org/10.1056/NEJMra1505256
  2. Coutsoudis A, Dabis F, Fawzi W, Gaillard P, Haverkamp G, Harris DR, et al., Breastfeeding and HIV International Transmission Study Group. Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis. J Infect Dis. 2004;189(12):2154–66. doi:.https://doi.org/10.1086/420834
  3. WHO. Updates on HIV and infant feeding [Internet]. WHO. [cited 2017 May 15]. Available from: http://www.who.int/nutrition/publications/hivaids/guideline_hiv_infantfeeding_2016/en/
  4. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al.; Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90. doi:.https://doi.org/10.1016/S0140-6736(15)01024-7
  5. Flynn PM, Taha TE, Cababasay M, Fowler MG, Mofenson LM, Owor M, et al.; PROMISE Study Team. Prevention of HIV-1 Transmission Through Breastfeeding: Efficacy and Safety of Maternal Antiretroviral Therapy Versus Infant Nevirapine Prophylaxis for Duration of Breastfeeding in HIV-1-Infected Women With High CD4 Cell Count (IMPAACT PROMISE): A Randomized, Open-Label, Clinical Trial. J Acquir Immune Defic Syndr. 2018;77(4):383–92. doi:.https://doi.org/10.1097/QAI.0000000000001612
  6. Evaluating Strategies to Reduce Mother-to-Child Transmission of HIV Infection in Populations Using Formula Feeding (PROMISE) - Full Text View - ClinicalTrials.gov [Internet]. [cited 2017 May 17]. Available from: https://clinicaltrials.gov/show/NCT01253538
  7. Hurst S. Ein paar Gedanken zum Thema Autonomie … 2016 [cited 2017 Jun 11]; Available from: http://dxdoiorg/1.044.14/sae.z20160483.2
  8. Kennedy CE, Yeh PT, Pandey S, Betran AP, Narasimhan M. Elective cesarean section for women living with HIV: a systematic review of risks and benefits. AIDS. 2017;31(11):1579–91. doi:.https://doi.org/10.1097/QAD.0000000000001535
  9. De Cock KM, Fowler MG, Mercier E, de Vincenzi I, Saba J, Hoff E, et al. Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. JAMA. 2000;283(9):1175–82. doi:.https://doi.org/10.1001/jama.283.9.1175
  10. Nduati R, John G, Mbori-Ngacha D, Richardson B, Overbaugh J, Mwatha A, et al. Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial. JAMA. 2000;283(9):1167–74. doi:.https://doi.org/10.1001/jama.283.9.1167
  11. Günthard HF, Frost SD, Leigh-Brown AJ, Ignacio CC, Kee K, Perelson AS, et al. Evolution of envelope sequences of human immunodeficiency virus type 1 in cellular reservoirs in the setting of potent antiviral therapy. J Virol. 1999;73(11):9404–12.
  12. Bispo S, Chikhungu L, Rollins N, Siegfried N, Newell M-L. Postnatal HIV transmission in breastfed infants of HIV-infected women on ART: a systematic review and meta-analysis. J Int AIDS Soc. 2017;20(1):21251. doi:.https://doi.org/10.7448/IAS.20.1.21251
  13. Kohler P, Schmidt AJ, Cavassini M, Furrer H, Calmy A, Battegay M, et al.; Swiss HIV Cohort Study. The HIV care cascade in Switzerland: reaching the UNAIDS/WHO targets for patients diagnosed with HIV. AIDS. 2015;29(18):2509–15. doi:.https://doi.org/10.1097/QAD.0000000000000878
  14. Rudin C, Spaenhauer A, Keiser O, Rickenbach M, Kind C, Aebi-Popp K, et al.; Swiss HIV Cohort Study (SHCS); Swiss Mother & Child HIV Cohort Study (MoCHiV). Antiretroviral therapy during pregnancy and premature birth: analysis of Swiss data. HIV Med. 2011;12(4):228–35. doi:.https://doi.org/10.1111/j.1468-1293.2010.00876.x
  15. WHO. Archived: Guidelines on HIV and infant feeding 2010 [Internet]. [cited 2018 Mar 22]. Available from: http://www.who.int/maternal_child_adolescent/documents/9789241599535/en/
  16. Tariq S, Elford J, Tookey P, Anderson J, de Ruiter A, O’Connell R, et al. “It pains me because as a woman you have to breastfeed your baby”: decision-making about infant feeding among African women living with HIV in the UK. Sex Transm Infect. 2016;92(5):331–6. doi:.https://doi.org/10.1136/sextrans-2015-052224
  17. Aebi-Popp K, Kouyos R, Bertisch B, Staehelin C, Rudin C, Hoesli I, et al.; Swiss Mother and Child HIV Cohort Study; Swiss HIV Cohort Study. Postnatal retention in HIV care: insight from the Swiss HIV Cohort Study over a 15-year observational period. HIV Med. 2016;17(4):280–8. doi:.https://doi.org/10.1111/hiv.12299
  18. Levison J, Weber S, Cohan D. Breastfeeding and HIV-infected women in the United States: harm reduction counseling strategies. Clin Infect Dis. 2014;59(2):304–9. doi:.https://doi.org/10.1093/cid/ciu272
  19. Shapiro RL, Hughes MD, Ogwu A, Kitch D, Lockman S, Moffat C, et al. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med. 2010;362(24):2282–94. doi:.https://doi.org/10.1056/NEJMoa0907736
  20. Shapiro RL, Kitch D, Ogwu A, Hughes MD, Lockman S, Powis K, et al. HIV transmission and 24-month survival in a randomized trial of HAART to prevent MTCT during pregnancy and breastfeeding in Botswana. AIDS. 2013;27(12):1911–20. doi:.https://doi.org/10.1097/QAD.0b013e32836158b0
  21. de Vincenzi I ; Kesho Bora Study Group. Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. Lancet Infect Dis. 2011;11(3):171–80. doi:.https://doi.org/10.1016/S1473-3099(10)70288-7
  22. Jamieson DJ, Chasela CS, Hudgens MG, King CC, Kourtis AP, Kayira D, et al.; BAN study team. Maternal and infant antiretroviral regimens to prevent postnatal HIV-1 transmission: 48-week follow-up of the BAN randomised controlled trial. Lancet. 2012;379(9835):2449–58. doi:.https://doi.org/10.1016/S0140-6736(12)60321-3
  23. White AB, Mirjahangir JF, Horvath H, Anglemyer A, Read JS. Antiretroviral interventions for preventing breast milk transmission of HIV. Cochrane Database Syst Rev. 2014;10(10):CD011323.
  24. Gamell A, Luwanda LB, Kalinjuma AV, Samson L, Ntamatungiro AJ, Weisser M, et al.; KIULARCO Study Group. Prevention of mother-to-child transmission of HIV Option B+ cascade in rural Tanzania: The One Stop Clinic model. PLoS One. 2017;12(7):e0181096. doi:.https://doi.org/10.1371/journal.pone.0181096
  25. Portman M, Parker H, Poole O, Wilson J. Two HIV-positive breastfeeding mothers in the UK – their story. Abstracts of the 19th Annual Conference of the British HIV Association (BHIVA) 2013; 16–19 April; Manchester UK. Poster no. 76. HIV Med. 2013;14(2):35. Available at: http://www.bhiva.org/documents/Conferences/2013Manchester/AbstractBook.pdf, https://www.ncbi.nim.nih.gov/pubmed?term=2355137.
  26. Luoga E, Vanobberghen F, Bircher R, Nyuri A, Ntamatungiro AJ, Mnzava D, et al. No HIV transmission from virally suppressed mothers during breastfeeding in rural Tanzania. J Acquir Immune Defic Syndr. 2018;1. doi:.https://doi.org/10.1097/QAI.0000000000001758
  27. Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, et al.; Rakai Project Study Group. Viral load and heterosexual transmission of human immunodeficiency virus type 1. N Engl J Med. 2000;342(13):921–9. doi:.https://doi.org/10.1056/NEJM200003303421303
  28. van der Ende ME, Regez RM, Schreij G, van der Meer JTM, Danner SA ; Dutch PEP registration. Post-exposure prophylaxis. Int J STD AIDS. 2002;13(1_suppl, Suppl 2):30–4. doi:.https://doi.org/10.1258/095646202762226137
  29. Sturt AS, Dokubo EK, Sint TT. Antiretroviral therapy (ART) for treating HIV infection in ART-eligible pregnant women. Cochrane Database Syst Rev. 2010;(3):CD008440.
  30. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al.; HPTN 052 Study Team. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med. 2016;375(9):830–9. doi:.https://doi.org/10.1056/NEJMoa1600693
  31. Webster DP. Is HIV post-exposure prophylaxis required following occupational exposure to a source patient who is virologically suppressed on antiretroviral therapy? HIV Med. 2015;16(2):73–5. doi:.https://doi.org/10.1111/hiv.12187
  32. Townsend CL, Byrne L, Cortina-Borja M, Thorne C, de Ruiter A, Lyall H, et al. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011. AIDS. 2014;28(7):1049–57. doi:.https://doi.org/10.1097/QAD.0000000000000212
  33. Willumsen JF, Filteau SM, Coutsoudis A, Newell M-L, Rollins NC, Coovadia HM, et al. Breastmilk RNA viral load in HIV-infected South African women: effects of subclinical mastitis and infant feeding. AIDS. 2003;17(3):407–14. doi:.https://doi.org/10.1097/00002030-200302140-00015
  34. Lunney KM, Iliff P, Mutasa K, Ntozini R, Magder LS, Moulton LH, et al. Associations between breast milk viral load, mastitis, exclusive breast-feeding, and postnatal transmission of HIV. Clin Infect Dis. 2010;50(5):762–9.
  35. Bae WH, Wester C, Smeaton LM, Shapiro RL, Lockman S, Onyait K, et al. Hematologic and hepatic toxicities associated with antenatal and postnatal exposure to maternal highly active antiretroviral therapy among infants. AIDS. 2008;22(13):1633–40. doi:.https://doi.org/10.1097/QAD.0b013e328307a029
  36. Thorne C, Newell M-L. Safety of agents used to prevent mother-to-child transmission of HIV: is there any cause for concern? Drug Saf. 2007;30(3):203–13. doi:.https://doi.org/10.2165/00002018-200730030-00004
  37. Williams PL, Hazra R, Van Dyke RB, Yildirim C, Crain MJ, Seage GR, 3rd, et al.; Pediatric HIV/AIDS Cohort Study. Antiretroviral exposure during pregnancy and adverse outcomes in HIV-exposed uninfected infants and children using a trigger-based design. AIDS. 2016;30(1):133–44.
  38. Heidari S, Mofenson L, Cotton MF, Marlink R, Cahn P, Katabira E. Antiretroviral drugs for preventing mother-to-child transmission of HIV: a review of potential effects on HIV-exposed but uninfected children. J Acquir Immune Defic Syndr. 2011;57(4):290–6. doi:.https://doi.org/10.1097/QAI.0b013e318221c56a
  39. Waitt CJ, Garner P, Bonnett LJ, Khoo SH, Else LJ. Is infant exposure to antiretroviral drugs during breastfeeding quantitatively important? A systematic review and meta-analysis of pharmacokinetic studies. J Antimicrob Chemother. 2015;70(7):1928–41.
  40. Harrigan PR, Hogg RS, Dong WWY, Yip B, Wynhoven B, Woodward J, et al. Predictors of HIV drug-resistance mutations in a large antiretroviral-naive cohort initiating triple antiretroviral therapy. J Infect Dis. 2005;191(3):339–47. doi:.https://doi.org/10.1086/427192
  41. Van de Perre P, Rubbo P-A, Viljoen J, Nagot N, Tylleskär T, Lepage P, et al. HIV-1 reservoirs in breast milk and challenges to elimination of breast-feeding transmission of HIV-1. Sci Transl Med. 2012;4(143):143sr3. doi:.https://doi.org/10.1126/scitranslmed.3003327
  42. Prazuck T, Chaillon A, Avettand-Fènoël V, Caplan A-L, Sayang C, Guigon A, et al. HIV-DNA in the genital tract of women on long-term effective therapy is associated to residual viremia and previous AIDS-defining illnesses. PLoS One. 2013;8(8):e69686. doi:.https://doi.org/10.1371/journal.pone.0069686
  43. King CC, Ellington SR, Davis NL, Coombs RW, Pyra M, Hong T, et al.; Partners in Prevention HSV/HIV Transmission Study and Partners PrEP Study Teams. Prevalence, Magnitude, and Correlates of HIV-1 Genital Shedding in Women on Antiretroviral Therapy. J Infect Dis. 2017;216(12):1534–40. doi:.https://doi.org/10.1093/infdis/jix550
  44. Agostoni C, Braegger C, Decsi T, Kolacek S, Koletzko B, Michaelsen KF, et al.; ESPGHAN Committee on Nutrition. Breast-feeding: A commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2009;49(1):112–25. doi:.https://doi.org/10.1097/MPG.0b013e31819f1e05
  45. Jakaitis BM, Denning PW. Human breast milk and the gastrointestinal innate immune system. Clin Perinatol. 2014;41(2):423–35. doi:.https://doi.org/10.1016/j.clp.2014.02.011
  46. Marchant A, Sadarangani M, Garand M, Dauby N, Verhasselt V, Pereira L, et al. Maternal immunisation: collaborating with mother nature. Lancet Infect Dis. 2017;17(7):e197–208. doi:.https://doi.org/10.1016/S1473-3099(17)30229-3
  47. Wang M, Li M, Wu S, Lebrilla CB, Chapkin RS, Ivanov I, et al. Fecal microbiota composition of breast-fed infants is correlated with human milk oligosaccharides consumed. J Pediatr Gastroenterol Nutr. 2015;60(6):825–33. doi:.https://doi.org/10.1097/MPG.0000000000000752
  48. Kuhn L, Kim H-Y, Hsiao L, Nissan C, Kankasa C, Mwiya M, et al. Oligosaccharide composition of breast milk influences survival of uninfected children born to HIV-infected mothers in Lusaka, Zambia. J Nutr. 2015;145(1):66–72. doi:.https://doi.org/10.3945/jn.114.199794
  49. Weng SF, Redsell SA, Swift JA, Yang M, Glazebrook CP. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Arch Dis Child. 2012;97(12):1019–26. doi:.https://doi.org/10.1136/archdischild-2012-302263
  50. Bowatte G, Tham R, Allen KJ, Tan DJ, Lau M, Dai X, et al. Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):85–95. doi:.https://doi.org/10.1111/apa.13151
  51. Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2014;(4):CD002971.
  52. Christensson K, Nilsson BA, Stock S, Matthiesen AS, Uvnäs-Moberg K. Effect of nipple stimulation on uterine activity and on plasma levels of oxytocin in full term, healthy, pregnant women. Acta Obstet Gynecol Scand. 1989;68(3):205–10. doi:.https://doi.org/10.3109/00016348909020990
  53. Watkins S, Meltzer-Brody S, Zolnoun D, Stuebe A. Early breastfeeding experiences and postpartum depression. Obstet Gynecol. 2011;118(2 Pt 1):214–21. doi:.https://doi.org/10.1097/AOG.0b013e3182260a2d
  54. Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):96–113. doi:.https://doi.org/10.1111/apa.13102
  55. Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB. Duration of lactation and incidence of type 2 diabetes. JAMA. 2005;294(20):2601–10. doi:.https://doi.org/10.1001/jama.294.20.2601
  56. Gunderson EP, Hurston SR, Ning X, Lo JC, Crites Y, Walton D, et al.; Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy Investigators. Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study. Ann Intern Med. 2015;163(12):889–98. doi:.https://doi.org/10.7326/M15-0807
  57. Elwyn G, Frosch D, Rollnick S. Dual equipoise shared decision making: definitions for decision and behaviour support interventions. Implement Sci. 2009;4(1):75. doi:.https://doi.org/10.1186/1748-5908-4-75
  58. Johnson G, Levison J, Malek J. Should Providers Discuss Breastfeeding With Women Living With HIV in High-Income Countries? An Ethical Analysis. Clin Infect Dis. 2016;63(10):1368–72. doi:.https://doi.org/10.1093/cid/ciw587
  59. Nachega JB, Uthman OA, Anderson J, Peltzer K, Wampold S, Cotton MF, et al. Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. AIDS. 2012;26(16):2039–52. doi:.https://doi.org/10.1097/QAD.0b013e328359590f
  60. Huntington S, Thorne C, Newell M-L, Anderson J, Taylor GP, Pillay D, et al.; UK Collaborative HIV Cohort (UK CHIC) Study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC). The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy. AIDS. 2015;29(17):2269–78. doi:.https://doi.org/10.1097/QAD.0000000000000826

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