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

Kahlert, Christian; Aebi-Popp, Karoline; Bernasconi, Enos; Martinez de Tejada, Begoña; Nadal, David; Paioni, Paolo; Rudin, Christoph; Staehelin, Cornelia; Wagner, Noémie; Vernazza, Pietro (2018). Is breastfeeding an equipoise option in effectively treated HIV-infected mothers in a high-income setting? Swiss medical weekly, 148, w14648. EMH Schweizerischer Ärzteverlag 10.4414/smw.2018.14648

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Aebi-Popp, Karoline and Staehelin, Cornelia

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1424-7860

Publisher:

EMH Schweizerischer Ärzteverlag

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

29 Aug 2018 09:35

Last Modified:

23 Oct 2019 16:07

Publisher DOI:

10.4414/smw.2018.14648

PubMed ID:

30044473

BORIS DOI:

10.7892/boris.119167

URI:

https://boris.unibe.ch/id/eprint/119167

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