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Benson J, Pierre C, Joseph NT. Updates in the Management of HIV During Pregnancy. Clin Obstet Gynecol 2024; 67:644-651. [PMID: 38946602 DOI: 10.1097/grf.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Human immunodeficiency virus in pregnant people remains a significant public health issue worldwide. The rate of perinatal transmission is 15% to 40% but can be decreased to less than 1% with appropriate antenatal management. Previous recommendations included a protease inhibitor-based antiretroviral therapy, infant prophylaxis, performance of cesarean section for uncontrolled viremia, and the use of formula for infant feeding. However, recent updates include first line of integrase inhibitor-based regimens and supporting parental choices for safe lactation. In this review, we summarize and provide updated recommendations for the care of people living with human immunodeficiency virus during pregnancy.
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Affiliation(s)
- Jemma Benson
- Division of Infectious Disease, Department of Medicine, Boston University School of Medicine
| | - Cassandra Pierre
- Division of Infectious Disease, Department of Medicine, Boston University School of Medicine
| | - Naima T Joseph
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
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2
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Chaparro AI, Formul D, Vasquez S, Cianelli R, Gonzalez IA, Scott G, De Santis JP. Breastfeeding in women with HIV infection: A qualitative study of barriers and facilitators. PLoS One 2024; 19:e0303788. [PMID: 39058709 DOI: 10.1371/journal.pone.0303788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/01/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Until recently, breastfeeding has been contraindicated for women living with HIV (WHIV) in the U.S. However, given the numerous health benefits of breastfeeding, recommendations have changed to support parental choice to breastfeed through shared decision-making. Although specific guidelines for managing the care of these women and their infants are not yet available, various approaches have been successful without infants acquiring HIV from their virologically suppressed mothers, thus, establishing breastfeeding as a viable option for the rising number of interested WHIV. This descriptive qualitative study aimed to identify factors influencing infant feeding choices decisions among WHIV in a multiethnic and multicultural population. METHODS AND FINDINGS A qualitative description design was used. WHIV who had given birth within 6 months were recruited using purposeful sampling. Data were collected using a semistructured interview guide in the participant's preferred language. Content analysis was used, and barriers and facilitators were separated and used to generate the themes and categories. In total, 20 participants were interviewed, and from these interviews, 11 barriers and 14 facilitators that influenced the decision to breastfeed were identified. Major barriers were related to the interference with daily activities, fear of transmission, lack of a standardized approach to education, and maternal concerns. Key facilitators included the benefits and advantages of breastmilk, access to more scientific research information on breastfeeding in the context of HIV, advice from a lactation consultant, emotional connection and attachment with the child, support from family and partners, empowering and supporting autonomy and decision-making about infant feeding, providing feeding choices, access to the lived experiences of women who have successfully breastfed their infants, and collaborative relationship with the physician and other healthcare providers. CONCLUSION The study identified barriers and facilitators to breastfeeding among WHIV that may influence their infant feeding decision-making process. More research is needed to guide the standardization of institutional policies and develop strategies to support breastfeeding in this population.
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Affiliation(s)
- Aida I Chaparro
- Division of Infectious Disease and Immunology, University of Miami Miller School of Medicine Department of Pediatrics, Miami, FL, United States of America
| | - Dieunane Formul
- Division of Infectious Disease and Immunology, University of Miami Miller School of Medicine Department of Pediatrics, Miami, FL, United States of America
| | - Stephanie Vasquez
- Division of Infectious Disease and Immunology, University of Miami Miller School of Medicine Department of Pediatrics, Miami, FL, United States of America
| | - Rosina Cianelli
- University of Miami School of Nursing and Health Studies Coral Gables, Coral Gables, FL, United States of America
| | - Ivan A Gonzalez
- Division of Infectious Disease and Immunology, University of Miami Miller School of Medicine Department of Pediatrics, Miami, FL, United States of America
| | - Gwendolyn Scott
- Division of Infectious Disease and Immunology, University of Miami Miller School of Medicine Department of Pediatrics, Miami, FL, United States of America
| | - Joseph P De Santis
- University of Miami School of Nursing and Health Studies Coral Gables, Coral Gables, FL, United States of America
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3
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Boyce TG, Havens PL, Henderson SL, Vicetti Miguel CP. From Guidelines to Practice: A Programmatic Model for Implementation of the Updated Infant Feeding Recommendations for People Living with HIV. J Pediatric Infect Dis Soc 2024; 13:381-385. [PMID: 38824437 DOI: 10.1093/jpids/piae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Thomas G Boyce
- Department of Pediatrics, Division of Infectious Diseases, Marshfield Clinic, Marshfield, WI, USA
| | - Peter L Havens
- Department of Pediatrics, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sheryl L Henderson
- Deparment of Pediatrics, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Claudia P Vicetti Miguel
- Department of Pediatrics, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, USA
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Powell A, Agwu A. In Support of Breast-/Chestfeeding by People With HIV in High-Income Settings. Clin Infect Dis 2024; 79:202-207. [PMID: 38270916 DOI: 10.1093/cid/ciae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 01/26/2024] Open
Abstract
Given that HIV can be transmitted through breastfeeding, historically, breastfeeding among women with HIV in the US and other resource-rich settings was discouraged. Formula feeding was the mandated feeding option out of concern for breast-milk transmission of HIV, which occurred in 16-24% of cases pre-antiretroviral therapy (pre-ART) use. In January 2023, the US Department of Health and Human Services' Perinatal Guidelines were revised to support shared decision-making for infant feeding choices. Updated clinical trials' data from resource-limited settings suggest the actual breastmilk HIV transmission rate in the context of maternal ART or neonatal postexposure prophylaxis is 0.3-1%. High-income countries are reporting more people with HIV breastfeeding their infants without cases of HIV transmission. We present the reasons for fully embracing breast-/chestfeeding as a viable, safe infant feeding option for HIV-exposed infants in high-income settings, while acknowledging unanswered questions and the need to continually craft more nuanced clinical guidance.
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Affiliation(s)
- Anna Powell
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison Agwu
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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5
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Espinal M, Yee LM, Fisher SA. Advances in HIV Management During Pregnancy and Infant Feeding. Infect Dis Clin North Am 2024:S0891-5520(24)00039-4. [PMID: 38969531 DOI: 10.1016/j.idc.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
Recent advances in human immunodeficiency virus (HIV) management during pregnancy and infant feeding encompass several key elements: expanded HIV testing guidance; growing evidence of safety, efficacy, and pharmacokinetic data favoring the use of preferred antiretroviral therapy (ART) during pregnancy and breastfeeding; increasing advocacy for the inclusion of pregnant individuals with HIV in clinical trials to expedite access to new ART; and updated guidelines supporting shared decision-making for choice of infant feeding methods in people with HIV.
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Affiliation(s)
- Mariana Espinal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2303, Chicago, IL, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2303, Chicago, IL, USA.
| | - Stephanie A Fisher
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2303, Chicago, IL, USA
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Nachman S, Aldrovandi G. Breastfeeding in the United States Among Women With HIV: Con Viewpoint. Clin Infect Dis 2024; 78:1629-1631. [PMID: 38185124 PMCID: PMC11175685 DOI: 10.1093/cid/ciad778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Indexed: 01/09/2024] Open
Abstract
To breast feed or not has long been a difficult question for women with human immunodeficiency virus (HIV) in high-income countries, as undetectable HIV in maternal plasma does not translate to zero risk of transmission while breastfeeding, and clean water and formula are readily available. Recent, and more permissive, changes in US and other high-income-country guidelines regarding breastfeeding underscore this issue and acknowledge the information gaps that are essential for informed maternal choice and provider management. These include lack of guidance as to routine monitoring of mothers during lactation, type and length of prophylaxis for infants, and lack of data on factors associated with increased breast-milk viral load and risk of transmission. Ancillary to data are the education and staffing needs for providers participating in the management of breastfeeding individuals. Future studies of breast-milk transmission will need to evaluate these gaps so that we can move transmission to zero.
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Affiliation(s)
- Sharon Nachman
- Department of Pediatrics, Renaissance School of Medicine, SUNY Stony Brook, Stony Brook, New York, USA
| | - Grace Aldrovandi
- Mattel Children's Hospital, UCLA School of Medicine, Los Angeles, California, USA
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7
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Abuogi L, Noble L, Smith C. Infant Feeding for Persons Living With and at Risk for HIV in the United States: Clinical Report. Pediatrics 2024; 153:e2024066843. [PMID: 38766700 DOI: 10.1542/peds.2024-066843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 05/22/2024] Open
Abstract
Pediatricians and pediatric health care professionals caring for infants born to people living with and at risk for HIV infection are likely to be involved in providing guidance on recommended infant feeding practices. Care team members need to be aware of the HIV transmission risk from breastfeeding and the recommendations for feeding infants with perinatal HIV exposure in the United States. The risk of HIV transmission via breastfeeding from a parent with HIV who is receiving antiretroviral treatment (ART) and is virally suppressed is estimated to be less than 1%. The American Academy of Pediatrics recommends that for people with HIV in the United States, avoidance of breastfeeding is the only infant feeding option with 0% risk of HIV transmission. However, people with HIV may express a desire to breastfeed, and pediatricians should be prepared to offer a family-centered, nonjudgmental, harm reduction approach to support people with HIV on ART with sustained viral suppression below 50 copies per mL who desire to breastfeed. Pediatric health care professionals who counsel people with HIV who are not on ART or who are on ART but without viral suppression should recommend against breastfeeding. Pediatric health care professionals should recommend HIV testing for all pregnant persons and HIV preexposure prophylaxis to pregnant or breastfeeding persons who test negative for HIV but are at high risk of HIV acquisition.
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Affiliation(s)
- Lisa Abuogi
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York
| | - Christiana Smith
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Djiadeu P, Begum H, Archibald C, Ekmekjian T, Busa G, Dansoh J, Van Nguyen P, Merckx J, Fleurant A. Risk of transmission of HIV to infants during breast/chest feeding when mothers/birthing parents living with HIV are on antiretroviral therapy: a protocol for a rapid review. BMJ Open 2024; 14:e084436. [PMID: 38719325 PMCID: PMC11086518 DOI: 10.1136/bmjopen-2024-084436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION HIV is a major public health issue affecting millions globally. Women and girls account for 46% of new HIV infections in 2022 and approximately 1.3 million females become pregnant every year. Vertical transmission of HIV from persons living with HIV (PLHIV) to infants may occur through different modalities, such as through breast/chest feeding. Notably, 82% of PLHIV who chose to breast/chest feed are on antiretroviral therapy (ART) when feeding their infants. Precise estimates of the risk of postpartum transmission to infants during breast/chest feeding at varying viral load levels remain a significant gap in the literature. METHODS AND ANALYSIS A rapid systematic search of electronic databases will be conducted from January 2005 to the present, including Medline, Embase and Global Health. The objective of this rapid review is to explore and assess the available evidence on the effect of varying viral load levels on the risk of HIV transmission to infants during breast/chest feeding when the birthing or gestational parent living with HIV is on ART. Study characteristics will be summarised and reported to support the narrative summary of the findings. The focus will be on the absolute risk of HIV transmission from birthing parent to infant during chest/breast feeding. The findings will also be stratified by month, including the risk of HIV transmission for 6 months and greater than 6 months postpartum. We will ascertain the risk of bias using A Measurement Tool to Assess Systematic Reviews 2, Quality of Prognosis Studies and Downs and Black checklist for the appropriate study type. A summary score will not be calculated, rather the strengths and limitations of the studies will be narratively described. ETHICS AND DISSEMINATION No human subjects will be involved in the research. The findings of this rapid review will inform a future systematic review and will be disseminated through peer-reviewed publications, presentations and conferences. PROSPERO REGISTRATION NUMBER CRD42024499393.
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Affiliation(s)
- Pascal Djiadeu
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Housne Begum
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Chris Archibald
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Giovanna Busa
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jeffery Dansoh
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Phu Van Nguyen
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Joanna Merckx
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Annie Fleurant
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Harris LR, Lee DH, Mareuil JW, Rakhmanina NY, Koay WLA. The Mental Health Effects and Experiences of Breastfeeding Decision-Making Among Postpartum Women Living with HIV. AIDS Behav 2024; 28:1186-1196. [PMID: 37505338 DOI: 10.1007/s10461-023-04142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Prior to January 2023, women living with HIV (WLWH) in the United States (US) were discouraged from breastfeeding due to the potential risk of mother-to-child HIV transmission through breastfeeding. Lack of breastfeeding decision-making and experience among WLWH may negatively affect maternal mental health. We implemented a quality improvement initiative to screen WLWH for postpartum depression (PPD), evaluate their attitudes toward breastfeeding, and assess their experience with breastfeeding decision-making. We collected quantitative data from WLWH using a voluntary, self-administered 6-item breastfeeding decision-making and experience survey (administered 1 month postpartum) and a 10-item Edinburgh Postnatal Depression Scale (EPDS, negative = 0-9; administered 1 and 4 months postpartum) tool. We conducted descriptive statistics and cross tabulation analysis. We analyzed 106 WLWH (93.4% non-Hispanic Black/African American; mean age 33.1 years; 82.1% HIV RNA < 200 copies/mL). One in five (19.1%) WLWH had a positive baseline EPDS screen, with the mean EPDS scores decreasing from 5.3 ± 5.4 (baseline) to 4.6 ± 4.8 (follow-up). Among 55 WLWH who provided baseline and follow-up EPDS scores, only 3/13 with a positive baseline EPDS screen had resolved depressive symptoms at follow-up. Over one-third (37.7%) of WLWH indicated feeling "sadness" when asked whether lack of breastfeeding negatively affected their feelings or emotions. Over half of WLWH (51.9%) were aware of the US breastfeeding recommendations, but the majority (60.4%) had never discussed breastfeeding options with a medical provider. Improved provider-patient discussions on infant feeding options among WLWH is needed to increase awareness of breastfeeding choices and promote informed, autonomous breastfeeding decision-making among WLWH.
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Affiliation(s)
- Leah R Harris
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
- General Dynamics Information Technology, Washington, DC, USA
| | - Do H Lee
- Department of Biostatistics and Bioinformatics, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Joanna W Mareuil
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
| | - Natella Y Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Technical Strategies and Innovation, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Wei Li A Koay
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA.
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Children's National Hospital, 111 Michigan Ave NW, West Wing Level 3.5 Suite 100, Washington, DC, 20010, USA.
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Bamford A, Foster C, Lyall H. Infant feeding: emerging concepts to prevent HIV transmission. Curr Opin Infect Dis 2024; 37:8-16. [PMID: 37889586 PMCID: PMC10734781 DOI: 10.1097/qco.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
PURPOSE OF REVIEW HIV screening in pregnancy, universal suppressive antiretroviral therapy (ART) and breastfeeding avoidance can almost completely prevent vertical transmission of HIV. Breastfeeding is associated with an additional risk of transmission, although this risk is extremely low with suppressive maternal ART. This minimal risk must be balanced with the benefits of breastfeeding for women living with HIV (WLHIV) and their infants. Guidance in high-income countries has evolved, moving towards supported breast feeding for women on suppressive ART. RECENT FINDINGS Breastmilk transmission accounts for an increasing proportion of new infant infections globally. The majority of transmission data comes from studies including women not on suppressive ART. Breastmilk transmissions in the context of undetectable viral load have rarely occurred, although risk factors remain unclear. Outcome data on supported breastfeeding are accumulating, providing evidence for guidelines and informing infant feeding decisions. Long-acting ART for maternal preexposure prophylaxis or treatment, and infant postnatal prophylaxis are promising future options. SUMMARY Breastfeeding on suppressive ART has a very low risk of vertical transmission and can have multiple benefits for WLHIV and their infants. However, caution is advised with relaxation of breastfeeding guidance so as not to jeopardise the global goal of elimination of vertical transmission by 2030.
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Affiliation(s)
- Alasdair Bamford
- Great Ormond Street Hospital for Children NHS Foundation Trust
- UCL Great Ormond Street Institute of Child Health
- MRC Clinical Trials Unit at UCL
| | - Caroline Foster
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Hermione Lyall
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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Moseholm E, Fetters MD, Aho I, Mellgren Å, Johansen IS, Katzenstein TL, Pedersen G, Storgaard M, Weis N. Perception and Emotional Experiences of Infant Feeding Among Women Living With HIV in a High-Income Setting: A Longitudinal Mixed Methods Study. J Acquir Immune Defic Syndr 2024; 95:52-64. [PMID: 37797230 DOI: 10.1097/qai.0000000000003314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The recommendation of breastfeeding avoidance for women living with HIV in high-income settings may be influenced by cultural beliefs and come at an emotional cost. This multicenter, longitudinal, convergent mixed methods study aimed to compare differences in attitudes, concerns, and experiences surrounding breastfeeding in women living with HIV of Nordic and non-Nordic origin. SETTING High-income setting. METHODS Pregnant women living with HIV in the Nordic countries Denmark, Finland, and Sweden were recruited in 2019-2020. Quantitative data on attitudes surrounding infant feeding were assessed using the Positive Attitudes Concerning Infant Feeding questionnaire completed in the third trimester (T1), and 3 (T2) and 6 (T3) months postpartum. Women who completed the survey were also invited to participate in semistructured interviews at T1 and T3. The findings from the quantitative survey and qualitative interviews were brought together through merging to assess for concordance, complementarity, expansion, or discordance between the data sets and to draw metainferences. RESULTS In total, 44 women completed the survey, of whom 31 also participated in qualitative interviews. The merged analyses identified three overarching domains representing commonalities across the quantitative and qualitative data: emotional impact, justifying not breastfeeding, and coping strategies. Not being able to breastfeed was emotionally challenging. Cultural expectations influenced the women's experiences and the strategies they used to justify their infant feeding choice. CONCLUSIONS For women living with HIV in Nordic countries not breastfeeding was a complex, multilayered process substantially influenced by social and cultural expectations.
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Affiliation(s)
- Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael D Fetters
- Mixed Methods Program and Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Inka Aho
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Åsa Mellgren
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; and
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Pollock L, Levison J. 2023 updated guidelines on infant feeding and HIV in the United States: what are they and why have recommendations changed. TOPICS IN ANTIVIRAL MEDICINE 2023; 31:576-586. [PMID: 38198669 PMCID: PMC10776031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The US Department of Health and Human Services guidelines on infant feeding among people with HIV have changed in response to (1) evidence of low risk of transmission via breast milk among individuals with consistent viral suppression, (2) considerations of equity and cultural norms, and (3) community desires. The 2023 guidelines recommend patient-centered shared decision-making. Individuals with HIV who are receiving antiretroviral therapy (ART) and have consistent viral suppression should be counseled on the options of for-mula feeding, feeding with banked donor milk, or breast (or chest) feeding, and nonjudgmentally supported in their decision. Individuals who choose to breastfeed should be counseled on and supported in adherence to ART, viral suppression, and engagement in postpartum care for themselves and their babies. Exclusive breastfeeding is recommended, with the understanding that brief periods of replacement feeding may be necessary. Data are lacking on ideal infant prophylaxis regimens.
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Nkulu-Kalengayi FK, Hurtig AK, Linander I. "Discrimination is harder to live with than the disease": an interview study of the perceptions and experiences of sexual and reproductive health and rights among women living with HIV in Sweden. Sex Reprod Health Matters 2023; 31:2245197. [PMID: 37671828 PMCID: PMC10484027 DOI: 10.1080/26410397.2023.2245197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Around 40% of people living with human immunodeficiency virus (HIV) in Sweden are women. However, little is known about their experiences, particularly those related to sexual and reproductive health and rights (SRHR). This study aims to explore perceptions and experiences of SRHR among women living with HIV (LWH). Twelve interviews were conducted with women LWH from September to October 2019 and analysed using thematic analysis. The central theme describing participants' experiences of social relationships, intimate encounters and reproductive life, "Discrimination is harder to live with than the disease itself", is based on three themes that contain subthemes. Theme 1 describes how participants reconsider and reorient their sexual and reproductive life after diagnosis. Theme 2 highlights how (mis)perceptions of HIV affect sexual and reproductive life and lead to abusive treatment and internalisation. Theme 3 describes a paradoxical shift of responsibilities where participants experience being compelled to take greater responsibility in some situations and stripped of the right to decide in others. This study suggests that despite notable progress in HIV treatment, stigma and discrimination stemming from outdated beliefs and (mis)conceptions, ambiguous policies and guidelines, and unequal access to information affect SRHR experiences of women LWH more than the virus itself. The results emphasise the need to: update knowledge within healthcare settings and among the public; clarify ambiguous legislations and guidelines; ensure equal access to information to enable all women LWH to take informed decisions, make fully informed choices and realise their SRHR; and consider the diversity of women LWH and enable shared decision-making.
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Affiliation(s)
| | - Anna-Karin Hurtig
- Professor, Department of Epidemiology and Global Health, Umeå University, SE-901 87Umeå, Sweden
| | - Ida Linander
- Associate Professor, Department of Epidemiology and Global Health, Umeå University, UmeåSE-901 87, Sweden
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14
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Levison J, McKinney J, Duque A, Hawkins J, Bowden EVH, Dorland J, Bitnun A, Kazmi K, Campbell DM, MacGillivray J, Yudin MH, Powell A, Datta S, Abuogi L, Weinberg A, Rakhmanina N, Mareuil JW, Hitti J, Boucoiran I, Kakkar F, Rahangdale L, Seidman D, Widener R. Breastfeeding Among People With Human Immunodeficiency Virus in North America: A Multisite Study. Clin Infect Dis 2023; 77:1416-1422. [PMID: 37078712 PMCID: PMC10654886 DOI: 10.1093/cid/ciad235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In North American countries, national guidelines have strongly recommended formula over breastmilk for people with human immunodeficiency virus (HIV) because of concern for HIV transmission. However, data from resource-limited settings suggest the risk is <1% among virally suppressed people. Information regarding breastfeeding experience in high-resource settings is lacking. METHODS A retrospective multisite study was performed for individuals with HIV who breastfed during 2014-2022 in the United States (8 sites) and Canada (3 sites). Descriptive statistics were used for data analysis. RESULTS Among the 72 cases reported, most had been diagnosed with HIV and were on antiretroviral therapy prior to the index pregnancy and had undetectable viral loads at delivery. Most commonly reported reasons for choosing to breastfeed were health benefits, community expectations, and parent-child bonding. Median duration of breastfeeding was 24 weeks (range, 1 day to 72 weeks). Regimens for infant prophylaxis and protocols for testing of infants and birthing parents varied widely among institutions. No neonatal transmissions occurred among the 94% of infants for whom results were available ≥6 weeks after weaning. CONCLUSIONS This study describes the largest cohort to date of people with HIV who breastfed in North America. Findings demonstrate high variability among institutions in policies, infant prophylaxis, and infant and parental testing practices. The study describes challenges in weighing the potential risks of transmission with personal and community factors. Finally, this study highlights the relatively small numbers of patients with HIV who chose to breastfeed at any 1 location, and the need for further multisite studies to identify best care practices.
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Affiliation(s)
- Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer McKinney
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alejandra Duque
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Joanna Hawkins
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Emily Ver Hoeve Bowden
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Julie Dorland
- Department of Obstetrics and Gynecology, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Kescha Kazmi
- Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Douglas M Campbell
- Department of Pediatrics, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Jay MacGillivray
- Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Mark H Yudin
- Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Anna Powell
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Shreetoma Datta
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Adriana Weinberg
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Natella Rakhmanina
- Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Joanna Walsh Mareuil
- Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jane Hitti
- Department of Maternal Fetal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, University of Montreal/Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Dominika Seidman
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, USA
| | - Rebecca Widener
- Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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15
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Z S, S S, N A H, S A I. Women's Experiences of Infant Feeding Practices While Living With HIV in Malaysia: A Community-Based Qualitative Study. J Hum Lact 2023; 39:701-710. [PMID: 37675867 DOI: 10.1177/08903344231195580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND With the advancement of antiretroviral therapy scale-up, it is possible for women living with HIV to breastfeed safely. However, this practice has not been adopted in Malaysia. Instead, infants are provided with subsidized human milk substitutes for their first 2 years of life. RESEARCH AIM This study describes the infant feeding experiences of women living with HIV in Malaysia. METHODS From August to October 2021, a nationwide, community-based qualitative study was conducted among women living with HIV and who received care from the Malaysian Ministry of Health. Using purposive sampling, participants who met the inclusion criteria were recruited. Interview and focus group transcripts were coded based on a secondary thematic analysis. RESULTS Six in-depth interviews and five focus group discussions were conducted among 32 participants. Study participants were mostly Malay secondary school graduates in their 30s and 40s. Due to the fear of vertical transmission, which was explained by healthcare providers to the participants, none of the women breastfed their infants. The three primary themes that emerged from analyzing the women's infant feeding experiences were (1) a human milk substitute was the only option and was encouraged; (2) feeding infants with a human milk substitute made the women feel incomplete as mothers; and (3) the women encountered difficulties in obtaining the subsidized human milk substitute. CONCLUSION Women living with HIV in Malaysia have been advised to provide human milk substitutes to their infants in fear of HIV transmission.
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Affiliation(s)
- Sulaiman Z
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Sukeri S
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Hamid N A
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ibrahim S A
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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16
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Clark RRS, Burwell N, Louis MJ, Philips JA. Research and Professional Literature to Inform Practice, November/December 2023. J Midwifery Womens Health 2023; 68:787-791. [PMID: 38087870 DOI: 10.1111/jmwh.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Rebecca R S Clark
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
- Pennsylvania Hospital, Philadelphia, Pennsylvania
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17
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Pagano-Therrien J, Griswold MK, Amoah RK. "Go With the Flow": A Qualitative Description of Infant Feeding Experiences Among Women With HIV in the United States. J Assoc Nurses AIDS Care 2023; 34:376-388. [PMID: 37199426 DOI: 10.1097/jnc.0000000000000411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
ABSTRACT Breastfeeding affords numerous health benefits to mothers and children, but for women with HIV in the United States, avoidance of breastfeeding is recommended. Evidence from low-income countries demonstrates low risk of HIV transmission during breastfeeding with antiretroviral therapy, and the World Health Organization recommends exclusive breastfeeding and shared decision making about infant feeding options in low-income and middle-income countries. In the United States, gaps in knowledge exist surrounding the experiences, beliefs, and feelings of women with HIV surrounding infant feeding decisions. Undergirded by a framework of person-centered care, this study describes the experiences, beliefs, and feelings of women with HIV in the United States surrounding recommendations for breastfeeding avoidance. Although no participants reported consideration of breastfeeding, multiple gaps were identified with implications for the clinical care and counseling of the mother-infant dyad.
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Affiliation(s)
- Jesica Pagano-Therrien
- Jesica Pagano-Therrien, PhD, RN, CPNP-PC is an Associate Professor, Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA. Michele K. Griswold, PhD, MPH, RN, IBCLC is an Assistant Professor, Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, Connecticut, USA. Rita Amoah, PhD, RN, is an Assistant Professor, Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA
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18
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Powell AM, Knott-Grasso MA, Anderson J, Livingston A, Rosenblum N, Sturdivant H, Byrnes KC, Martel K, Sheffield JS, Golden WC, Agwu AL. Infant feeding for people living with HIV in high resource settings: a multi-disciplinary approach with best practices to maximise risk reduction. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100509. [PMID: 37287494 PMCID: PMC10242550 DOI: 10.1016/j.lana.2023.100509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 06/09/2023]
Abstract
Shared decision making for infant feeding in the context of HIV in high-resourced settings is necessary to acknowledge patient autonomy, meet increasing patient requests and address the changing reality of perinatal HIV care. In low-to middle-income countries (LMIC), where the majority of individuals living with HIV reside, persons with HIV are recommended to breastfeed their infants. In the setting of maternal anti-retroviral therapy (ART) use throughout pregnancy, viral suppression and appropriate neonatal post-exposure prophylaxis (PEP) use, updated information indicates that the risk of HIV transmission through breastmilk may be between 0.3 and 1%. While not endorsing or recommending breastfeeding, the United States' DHHS perinatal guidelines are similarly pivoting, stating that individuals should "receive patient-centred, evidence-based counselling on infant feeding options." Similar statements appear in the British, Canadian, Swiss, European, and Australasian perinatal guidelines. We assembled a multi-disciplinary group at our institution to develop a structured shared decision-making process and protocol for successful implementation of breastfeeding. We recommend early and frequent counselling about infant feeding options, which should include well known benefits of breastfeeding even in the context of HIV and the individual's medical and psychosocial circumstances, with respect and support for patient's autonomy in choosing their infant feeding option.
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Affiliation(s)
- Anna M. Powell
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mary Ann Knott-Grasso
- Division of Adolescent and Young Adult Health, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jean Anderson
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alison Livingston
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nadine Rosenblum
- Department of Obstetrics and Gynecology, Perinatal Lactation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Heather Sturdivant
- Department of Obstetrics and Gynecology, Perinatal Lactation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kristen C. Byrnes
- Eudowood Neonatal Pulmonary Division, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jeanne S. Sheffield
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - W. Christopher Golden
- Eudowood Neonatal Pulmonary Division, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison L. Agwu
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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19
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Crisinel PA, Kusejko K, Kahlert CR, Wagner N, Beyer LS, De Tejada BM, Hösli I, Vasconcelos MK, Baumann M, Darling K, Duppenthaler A, Rauch A, Paioni P, Aebi-Popp K. Successful implementation of new Swiss recommendations on breastfeeding of infants born to women living with HIV. Eur J Obstet Gynecol Reprod Biol 2023; 283:86-89. [PMID: 36801775 DOI: 10.1016/j.ejogrb.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Swiss national recommendations advise, since end of 2018, supporting women with HIV who wish to breastfeed. Our objective is to describe the motivational factors and the outcome of these women and of their infants. METHODS mothers included in MoCHiV with a delivery between January 2019 and February 2021 who fulfilled the criteria of the "optimal scenario" (adherence to cART, regular clinical care, and suppressed HIV plasma viral load (pVL) of <50 RNA copies/ml) and who decided to breastfeed after a shared decision-making process, were approached to participate in this nested study and asked to fill-in a questionnaire exploring the main motivating factors for breastfeeding. RESULTS Between January 9, 2019 and February 7, 2021, 41 women gave birth, and 25 decided to breastfeed of which 20 accepted to participate in the nested study. The three main motivational factors of these women were bonding, neonatal and maternal health benefits. They breastfed for a median duration of 6.3 months (range 0.7-25.7, IQR 2.5-11.1). None of the breastfed neonates received HIV post-exposure prophylaxis. There was no HIV transmission: 24 infants tested negative for HIV at least 3 months after weaning; one mother was still breastfeeding when we analyzed the data. CONCLUSIONS As a result of a shared decision-making process, a high proportion of mothers expressed a desire to breastfeed. No breastfed infant acquired HIV. The surveillance of breastfeeding mother-infant pairs in high resource settings should be continued to help update guidelines and recommendations.
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Affiliation(s)
- Pierre Alex Crisinel
- Unit of Pediatric Infectious Diseases and Vaccinology, Department Women Mother Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Katharina Kusejko
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christian R Kahlert
- Infectious Diseases & Hospital Epidemiology, Children's Hospital of Eastern Switzerland and Cantonal Hospital, St. Gallen, Switzerland
| | - Noémie Wagner
- Pediatric Infectious Diseases Unit, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Leila Sultan Beyer
- Department of Obstetrics and Gynecology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Begoña Martinez De Tejada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospitals, of Geneva, Geneva, Switzerland
| | - Irene Hösli
- University Hospital Basel and University of Basel, Basel, Switzerland
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Marc Baumann
- Department of Obstetrics and Gynecology, Bern University Hospital, Bern, Switzerland
| | - Katharine Darling
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea Duppenthaler
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland; Department of Obstetrics and Gynecology, Lindenhofspital, Bern, Switzerland.
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20
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McKinney J, Mirani G, Levison J. Providers Have a Responsibility to Discuss Options for Infant Feeding With Pregnant People With Human Immunodeficiency Virus in High-Income Countries. Clin Infect Dis 2023; 76:535-539. [PMID: 36097892 DOI: 10.1093/cid/ciac761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 11/12/2022] Open
Abstract
Guidelines in high-income countries generally recommend against breastfeeding for a pregnant person with HIV due to the historical risk of transmission to the infant and generally acceptable, safe, and sustainable access to formula. Maternal antiretroviral therapy and infant prophylaxis have been shown to significantly decrease the risk of transmission during breastfeeding. In addition, formula may not be acceptable to patients for a variety of cultural, social, or personal reasons, and its sustainability is called into question in the setting of the current nationwide formula shortage. Providers caring for pregnant people with HIV have a responsibility to discuss infant feeding with their patients, and help them weigh the risks and benefits within the limits of the current body of evidence. We outline a process, including a written agreement, that can be used to discuss infant feeding with all patients and help them make the best decision for their family.
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Affiliation(s)
- Jennifer McKinney
- Department of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Gayatri Mirani
- Division of Allergy, Immunology, and Retrovirology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
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21
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Aleshire K, Bazzi R. Management Strategies in Perinatal HIV. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.105451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Current management of perinatal HIV infections and exposures involves the administration of antiretroviral therapy to both the pregnant mother and to her child after delivery. Striving to achieve safe and effective medication management is key in preventing new pediatric HIV infections. Maternal HIV testing and subsequent monitoring can help to identify fetal HIV exposures during pregnancy, maternal nonadherence, insufficient treatment regimens, and otherwise undiscovered exposures during the delivery process. There are several well-constructed guidelines that offer expert references for healthcare providers. This chapter will summarize current recommendations from the United States, with a brief insight into select international guidelines. Although available guidelines provide a structured framework for the healthcare team, there has recently been a significant drive to advance current perinatal management and outcomes.
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22
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Koay WLA, Rakhmanina NY. Supporting Mothers Living With HIV in the United States Who Choose to Breastfeed. J Pediatric Infect Dis Soc 2022; 11:239. [PMID: 35238385 DOI: 10.1093/jpids/piac005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Wei Li A Koay
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA.,Department of Pediatrics, The School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Natella Y Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA.,Department of Pediatrics, The School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.,Elizabeth Glaser Pediatric AIDS Foundation, Technical Strategies and Innovation, Washington, DC, USA
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23
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Eidelman AI. Breastfeeding and Maternal Viral Infections: It Is Not Just a Matter of COVID-19-What About HIV. Breastfeed Med 2022; 17:91-92. [PMID: 35021864 DOI: 10.1089/bfm.2021.29201.aie] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Arthur I Eidelman
- -Arthur I. Eidelman, MD, FABM, Editor-in-Chief, Breastfeeding Medicine
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