Question | Discussion | References

Updated March 14, 2012

Breastfeeding for HIV-infected Mothers in Resource-Limited Settings

Authors: Alison C. Roxby, MD, MSc Grace John-Stewart, MD, PhD Christopher Behrens, MD

A 26-year-old HIV-infected woman from sub-Saharan Africa presents with her 6-week old infant to an outpatient clinic for infant immunizations. The mother is WHO Stage 1 and has an absolute CD4 count of 650 cells/mm3. She completed short-course zidovudine from 20 weeks gestation to delivery, received single dose nevirapine in labor, and 1 week of zidovudine and lamivudine postpartum. She is exclusively breastfeeding (the infant receives no supplemental fluids or foods apart from breast milk) and has been giving her infant daily nevirapine syrup since birth. She is concerned about continuing to breastfeed and is considering weaning her infant to reduce the risk of HIV transmission. She lives in a slum neighborhood, cooks over a wood fire, retrieves her water from a communal tap, and says that she cannot afford infant formula.

Which of the following would you recommend for this mother?

A The mother should wean the infant rapidly, using porridge for infant food and adding milk when it is available.
B The mother should continue to give her infant daily nevirapine prophylaxis while exclusively breastfeeding for 6 months and during continued breastfeeding for 12 months.
C The mother should stop breastfeeding since this infant's risk of acquiring HIV infection from breast milk outweighs the risk of dying from diarrheal illness or pneumonia in the first year of life.
D The mother should discontinue antiretroviral therapy prophylaxis since the infant's risk of acquiring HIV infection from breast milk is highest in the first 6 weeks postpartum and drops sharply thereafter.