Is breastfeeding an equipoise option in effectively treated HIV-infected mothers in a high-income setting?
Christian R. Kahlert, Karoline Aebi-Popp, Enos Bernasconi, Begoña Martinez De Tejada, David Nadal, Paolo Paioni, Christoph Rudin, Cornelia Staehelin, Noémie Wagner & Pietro Vernazza
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abstract
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Combined antiretroviral treatment (cART) has reduced mother-to-child
transmission (MTCT) of the human immunodeficiency virus (HIV) to
virtually zero in industrialised countries, where strictly bottle
feeding is recommended for HIV-infected mothers, and to as low as
0.7% after 12 months in low-resource settings, where breastfeeding
is strongly encouraged. Given the theoretically very low risk of
transmission by breastfeeding with cART, and the advantages and
benefits of breastfeeding, also in industrialised countries, the
strong recommendation to HIV-infected mothers to refrain from
breastfeeding in this setting may no longer be justified. We have
evaluated risks of breastfeeding for HIV MTCT in the light of
accessible cART, the general benefits of breastfeeding, and the
women's autonomy to consent to any intervention. As we found no
evidence in the literature of HIV MTCT via breastfeeding whilst on
effective cART, we identified a situation of clinical equipoise. We
propose how to proceed in Switzerland when HIV-infected women
consider breastfeeding. We advocate a shared decision-making process
and suggest a list of topics on which to provide unbiased
information for the HIV-infected mother to enable her comprehensive
understanding of one or the other decision. Although breastfeeding
still should not be actively recommended in Switzerland, any
HIV-infected mother, regardless of her geographical and cultural
background, who decides to breastfeed should be supported by the
best strategy to achieve optimal medical care for both herself and
her child. This includes continuous support of cART adherence and
regular maternal HIV plasma viral load monitoring.
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citation
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Kahlert C R, Aebi-Popp K, Bernasconi E, Martinez de Tejada B, Nadal
D, Paioni P, Rudin C, Staehelin C, Wagner N, Vernazza P. Is
breastfeeding an equipoise option in effectively treated
HIV-infected mothers in a high-income setting?. Swiss Med Wkly 2018;
148:w14648.
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type
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journal paper/review (English)
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date of publishing
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23-7-2018
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journal title
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Swiss Med Wkly (148)
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ISSN electronic
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1424-3997
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pages
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w14648
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PubMed
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30044473
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DOI
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10.4414/smw.2018.14648
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contact
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Christian R. Kahlert
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additional links & downloads
