Stopping Breastfeeding and Care of the HIV-exposed but Uninfected Infant

 

 

 

 

 

 

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Stopping Breastfeeding

• Mothers living with HIV who decide to stop breastfeeding should do so gradually over a period of a month.
  Abrupt cessation of breastfeeding is not recommended and may increase the VL in breastmilk. If subsequent intermittent breastfeeding should occur, the infant is at increased risk of becoming HIV infected.
• Infants who have been receiving ART prophylaxis should continue prophylaxis for four weeks after all breastfeeding has stopped.
• Children must receive an adequate diet following cessation of breastfeeding as outlined in the Infant and Young Child Feeding Policy

Indications for Formula Feeding to be provided by the Dept of Health Supplementation Scheme

1. Infants of mothers who are failing TLD2 or third-line ARV treatment (VL ≥1000 c/mL)
   Note: Although breastfeeding in women with an unsuppressed VL on TLD 2 or 3rd line ART is not recommended due to the risk of resistant HIV transmission, exclusively formula feeding may also pose risks to vulnerable children. These mother-baby pairs should be referred or discussed with a team of experts, and social circumstances considered. If formula feeding is deemed the lesser risk, intensive formula feeding support and close monitoring by the therapeutic nutrition programme are recommended. See also the “VL Non-Suppression Algorithm”.
2. The mother has died, or the infant has been abandoned.
3. Other individual circumstances deemed necessary by a multidisciplinary team including certain metabolic conditions in the infant, medical conditions in the mother, or certain maternal medications as outlined in the PHC EML.

Where there are legitimate medical conditions, as diagnosed by a medical practitioner, or when a mother is incapable of caring for her infant or young child, health care personnel should recommend appropriate infant formula feeding as an alternative feeding option for up to 12 months of age. The mother/caregiver should receive appropriate counselling on the safe preparation of formula, the age-appropriate quantities and how to cup feed. Once the child reaches 12 months of age, pasteurised full cream milk (400-600ml/day) should be recommended, as ongoing formula for children older than 12 months is not necessary.

Care of the HIV-Exposed but Uninfected Infant

More than 25% of the total infant population in SA are HIV-exposed and more than 98% of these infants are HIV negative. Yet, having escaped HIV infection, they may still suffer the consequences of being born to a woman living with HIV. HIV-exposed but Uninfected (HEU) children still require:

Routine Child Health Management

• Manage and treat acute problems according to the IMCI guidelines
• Provide feeding counselling and support
• Monitor growth and development
• Provide routine immunisations, Vit A, and deworming
• Screen for TB symptoms and TB index cases and manage accordingly
• Ask about mother’s health, ART adherence, and contraception needs
• Provide social support and counselling for age-appropriate parental disclosure

Routine Management for the HIV-Exposed Infant

• Ongoing interventions to prevent vertical transmission through breastfeeding
• All routine HIV tests as indicated in this guideline for HIV-exposed infants

Additional Management for the HEU Infant

HEU infants may experience poorer outcomes despite being HIV uninfected, and may require more regular follow-up.

Identify high-risk HEU infants who may require closer monitoring, including those with:

• Poor birth outcomes
• Symptoms of anaemia
• Impaired growth and/or neurodevelopment
• History of hospitalisation
• Maternal illness or death

Ongoing Care for the Mother and her Family

• Remember to provide appropriate ongoing care to the women living with HIV and her family.
• If a breastfeeding mother is sick or hospitalised, consider appropriate ways she can continue breastfeeding. If not, ensure that baby receives appropriate care whilst mother is hospitalised.
• Screen partner and other children for HIV and other infectious disease as indicated (e.g. TB)

Click here for the pdf.

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South African National Department of Health, Guideline for Vertical Transmission Prevention of Communicable Infections, Version 2_August 2023