Successful implementation of new Swiss recommendations on breastfeeding of infants born to women living with HIV

Crisinel, Pierre Alex; Kusejko, Katharina; Kahlert, Christian R.; Wagner, Noémie; Beyer, Leila Sultan; Tejada, Begoña Martínez de; Hösli, Irène; Vasconcelos, Malte Kohns; Baumann, Marc; Darling, Katharine; Duppenthaler, Andrea; Rauch, Andri; Paioni, Paolo; Popp, Karoline Aebi

doi:10.1016/j.ejogrb.2023.02.013

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…This is comparable with the proportion of the participants that would like to breastfeed despite living with HIV in the previous studies from the United Kingdom (38%) and Switzerland (49%). 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

“… 16 , 17 In addition, one-third to half of the study participants from studies in the United Kingdom and Switzerland indicated that they would like to breastfeed despite having HIV. 18 , 19 Little is known about the breastfeeding desires among women living with HIV in the Netherlands. Also, the prevalence of breastfeeding despite medical advice to formula feed is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Exploring the Breastfeeding Desires and Decision-Making of Women Living with HIV in the Netherlands: Implications for Perinatal HIV Management in Developed Countries

Bukkems

Finkenflügel

Grintjes

et al. 2023

Breastfeeding Medicine

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Introduction: Guidelines in high-income countries recommend women living with human immunodeficiency virus (HIV) to formula feed their newborns, because the possibility of mother-to-child-transmission of HIV during breastfeeding cannot be ruled out. It is an ongoing debate if the possible transmission risk outweighs the medical, cultural, psychological, and social importance of breastfeeding in women stable on current first-line suppressive antiretroviral regimens. The study aim was to explore breastfeeding desires and decision-making of immigrant and nonimmigrant women living with HIV in the Netherlands. Method: A questionnaire was administered orally or online to 82 women living with HIV in the Netherlands. The breastfeeding desires of the participants were collected as categorical data, and breastfeeding decision-making and willingness to adhere to additional monitoring were collected on a 5-point Likert scale. Categorical data were presented as proportions, and Likert scale data were presented in Likert scale bar plots. Results: Seventy-one percent of the participants expressed a desire to breastfeed in the future. The most important factors influencing decision-making to breastfeed were the chance of transmission of HIV to the infant and the advice by the doctor or nurse practitioner. Of the participants, 42% expressed their interest in breastfeeding with a <1/100 transmission risk. More than half of the participants expressed their interest to breastfeed with additional monitoring. Conclusions: A substantial proportion of the women living with HIV in the Netherlands has a desire to breastfeed, of which the majority are willing to adhere to additional monitoring to do so.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exploring the Breastfeeding Desires and Decision-Making of Women Living with HIV in the Netherlands: Implications for Perinatal HIV Management in Developed Countries

Bukkems

Finkenflügel

Grintjes

et al. 2023

Breastfeeding Medicine

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“…21 After adoption of new guidelines, supporting shared decision-making in Switzerland since 2019, nearly half of WLWH decided to breastfeed, all of which had suppressed mVL at delivery. 22 More clinicians challenge avoidance of breastfeeding in high-income countries and favor an interdisciplinary and open discussion about infant feeding in WLWH. 13,14,17,23 Although breastfeeding poses the possible risk of VT, it concurrently offers maternal health benefits, including superior uterus involution, reduced risk of depression, obesity, cancer, or diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…However, they are difficult to undertake because of low prevalence, 1 and no prospective study has been conducted to assess VT in this setting. 4 Even reports of breastfeeding in high-income countries with ongoing cART are rare 7,21,22,32 : Colleagues from Belgium published 2 cases of WLWH breastfeeding on cART under close monitoring and extended infant prophylaxis. 7 In 2 WLWH from the United Kingdom, no VT was reported after breastfeeding for 6 weeks, respectively, 5 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…4,7,33,34 In our cohort, 5 WLWH who did breastfeed even declined infant prophylaxis entirely. Besides the Swiss report from 2021, 22 this is the second report in breastfeeding WLWH cohorts from high-income countries where infant prophylaxis was not applied over the whole breastfeeding period. 7,[32][33][34] The presented analysis shows that women may decide to breastfeed even if an optimal scenario is not present.…”

Section: Discussionmentioning

confidence: 99%

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Brief Report: HIV-Positive and Breastfeeding in High-Income Settings: 5-Year Experience From a Perinatal Center in Germany

Weiß

Both

Rack-Hoch

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Exclusive breastfeeding is recommended for women living with HIV (WLWH) in low-income-but not in high-incomecountries, where milk substitutes are preferred. Some guidelines for highincome countries opted for a shared decision-making process regarding breastfeeding in optimal scenarios with adherence to antiretroviral therapy (cART), suppressed maternal viral load (mVL), and clinical monitoring. Although vertical transmission (VT) risk under cART is estimated below 1% in low-income settings, data from high-income countries are rare. Methods:We retrospectively analyzed all 181 live births from WLWH at the LMU Munich university hospital perinatal center in Germany between January 2016 and December 2020. We focused on VT, suppressed mVL and optimal scenario rates, breastfeeding frequency, cART regimens, and infant prophylaxis. All women were counseled according to current guidelines, foremost recommending avoidance of breastfeeding.Results: In the 5-year cohort, no VT was observed. One hundred fifty-one WLWH (83.4%) decided not to breastfeed, even in optimal scenarios. Thrity infants (16.6%) were nursed, of which 25 were within an optimal scenario, whereas in 5 cases, breastfeeding was performed with a detectable VL in pregnancy or the postpartum period. All WLWH were treated with cART at delivery, and 91.7% sustained suppressed mVL. Zidovudine infant prophylaxis was given between 2 and 8 weeks but not necessarily over the whole breastfeeding duration and was declined from 5 breastfeeding WLWH.Conclusions: Although the cohort is too small to assess VT risk through breastfeeding with cART-suppressed mVL, breastfeeding might be an alternative even in high-income countries, but further studies are needed.

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Experiencia de la cohorte nacional de mujeres embarazadas que viven con VIH y sus hijos en España: evolución de la transmisión materno-infantil de VIH e infecciones asociadas

Illán Ramos,

Berzosa Sánchez,

Carrasco García

et al. 2024

Anales de Pediatría

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Successful implementation of new Swiss recommendations on breastfeeding of infants born to women living with HIV

Cited by 9 publications

References 15 publications

Exploring the Breastfeeding Desires and Decision-Making of Women Living with HIV in the Netherlands: Implications for Perinatal HIV Management in Developed Countries

Exploring the Breastfeeding Desires and Decision-Making of Women Living with HIV in the Netherlands: Implications for Perinatal HIV Management in Developed Countries

Brief Report: HIV-Positive and Breastfeeding in High-Income Settings: 5-Year Experience From a Perinatal Center in Germany

Experiencia de la cohorte nacional de mujeres embarazadas que viven con VIH y sus hijos en España: evolución de la transmisión materno-infantil de VIH e infecciones asociadas

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