Today, HIV treatments prevent the transmission of the virus from mother to child during childbirth. On the other hand, for breastfeeding, the lack of scientific data provides few answers to the question. As a result, recommendations vary from country to country.
In France, thanks to antiretroviral treatments administered to mothers HIV positivethere not had a single mother-to-child transmission between 2018 and 2021. If the risk is nil during childbirththe question of breastfeeding motherhood arises for many women affected by the infection. It is estimated thatin the absence of treatmenta breastfed infant 30% risk of contracting the virus. But what if a treatment is put in place? There are few concrete answers to this question.
“Contraindicated” in France
In France, the Morlat report of 2017 on the Medical care for people living with HIV indicates that breastfeeding is “contraindicated” and recommends the use of artificial milk to feed the baby. However, several studies, including one from the ANRS published in 2016, show that taking a treatment by mother or child reduces the risk of transmission during breastfeeding. Which is not enough for the authors of the report. This research is mostly conducted on population cohorts from African countries. “Despite the data in Africa on the low risk of transmission from breastfeeding secured by antiretrovirals in the mother or child throughout the duration of breastfeeding, the residual risk of transmission is not zero”.
Globally, the WHO recommends for low-income countries, exclusive breastfeeding until 12 months of the child, when the mother receives antiretroviral treatment. In Europe, several countries offer support medical service to HIV-positive women who want or need to breast-feed. This is the case of Switzerland, Germany and England.
Recommendations that might change
Faced with these neighbours, France, driven by the action of associations such as the Family Committee, Actions Treatments and Draw Me a Sheep, is in the process of review its recommendations. Last May, a manifestowritten by the three structures, is even published so that the French instructions opt for leave the choice mothers living with HIV and accompany them in case of breastfeeding. Organizations are also asking for “collect and pool data on several northern countries” to better determine the risk of transmission when a treatment is put in place.
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