Breastfeeding and the 2015 South African Guidelines for Prevention of Mother-To-Child Transmission of HIV
Abstract
Breastfeeding, especially exclusive breastfeeding in the first months of life, is the cornerstone of good infant nutrition, health and survival. The various health benefits include the mother and also extend beyond infancy to protection against common noncommunicable diseases in adult life. These benefits take on even greater salience in low-resource settings.
Mother-to-child transmission (MTCT) of HIV through breastfeeding and the Centers for Disease Control’s initial recommendation that HIV-infected women avoid breastfeeding their infants, threatened this key child health-promoting activity. Support for breastfeeding by HIV-infected women is steadily being reinstated, however. This change was prompted by numerous reports that formula feeding incurred significant harm and was also facilitated by a 1999 report that showed significantly reduced postnatal HIV transmission if breastfeeding was exclusive. Further impetus came from a demonstration that postnatal transmission is almost eliminated if maternal combination antiretroviral treatment (cART) or extended infant antiretroviral peri-exposure prophylaxis (PEEP) is provided during breastfeeding. In 2012, even the British HIV Association (BHIVA) guidelines permitted breastfeeding under tightly controlled circumstances, if mothers insisted.
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