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World Health Organization 2006 guidelines on HIV and infant feeding

In October 2006, the World Health Organization published updated international guidelines on HIV and infant feeding based on the technical consultation held on behalf of the Interagency Task Team (IATT) on Prevention of HIV Infection in Pregnant Women, Mothers and Their Infants. The participants at the consultation reviewed new evidence and experience regarding HIV and infant feeding since a previous technical consultation in October 2000. As a result, the group endorsed the general principles underpinning the October 2000 recommendations and reached a consensus on a range of issues for infant feeding options based on individual circumstances of HIV-positive mothers.

The guidelines aim to improve the way HIV-affected infants and young children are fed to increase infant survival while minimizing the risk of HIV transmission. To adopt and put these recommendations into practice, countries need financial and technical support to revise policies, build the capacity of health staff to effectively use the new recommendations, and to monitor the results. The IYCN Project assists countries at both the policy and program levels to operationalize the guidelines.

The recommendations from WHO’s HIV and Infant Feeding Update based on the technical consultation are:  

  • “The most appropriate infant feeding option for an HIV-infected mother depends on her individual circumstances, including her health status and the local situation, but should take greater consideration of the health services available and the counselling and support she is likely to receive.
  • Exclusive breastfeeding is recommended for HIV-infected women for the first six months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for them and their infants before that time.
  • When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected women is recommended.
  • At six months, if replacement feeding is still not acceptable, feasible, affordable, sustainable and safe, continuation of breastfeeding with additional complementary foods is recommended, while the mother and baby continue to be regularly assessed. All breastfeeding should stop once a nutritionally adequate and safe diet without breast milk can be provided.1
  • All HIV-infected mothers should receive counseling which includes provision of general information about the risks and benefits of various infant feeding options, and specific guidance in selecting the option most likely to be suitable for their situation. Whatever a mother decides, she should be supported in her choice.
  • Adequate numbers of people who can counsel HIV-infected women on infant feeding should be trained, deployed, supervised and supported. Such support should include updated training as new information and recommendations emerge.
  • When HIV-infected mothers choose not to breastfeed from birth or stop breastfeeding later, they should be provided with specific guidance and support for at least the first two years of the child’s life to ensure adequate replacement feeding. Programmes should strive to improve conditions that will make replacement feeding safer for HIV-infected mothers and families.
  • Information and education on mother-to-child transmission of HIV should be urgently directed to the general public, affected communities and families.
  • HIV-infected mothers who breastfeed should be:
    a. assisted to ensure that they use a good breastfeeding technique to prevent breast problems, which should be treated promptly if they occur;
    b. provided with specific guidance and support when they cease breastfeeding to avoid harmful nutritional and psychological consequences and maintain breast health.
  • Whatever the mother’s decision on infant feeding, health services should follow up all HIV-exposed infants, and continue to offer infant feeding counseling and support, particularly at key points when feeding decisions may be reconsidered, such as at the time of early infant HIV diagnosis and at six months of age.
  • Breastfeeding mothers of infants and young children who [also] are known to be HIV-infected should be strongly encouraged to continue breastfeeding as per the recommendations for the general population, that is up to two years or beyond.
  • National programmes should provide all HIV-exposed infants and their mothers with a full package of child survival and reproductive health interventions2 with effective linkages to HIV prevention, treatment and care services. In addition, health services should make special efforts to support primary prevention for women who test negative in antenatal and delivery settings, with particular attention to the breastfeeding period.
  • Governments should ensure that the package of interventions referenced above, as well as the conditions described in current guidance3, are available before any distribution of free commercial infant formula is considered.
  • Governments, other stakeholders and donors should greatly increase their commitment and resources for implementation of the Global Strategy for Infant and Young Child Feeding and the United Nations HIV and Infant Feeding Framework for Priority Action in order to effectively prevent postnatal HIV infections, improve HIV-free survival and achieve relevant United Nations General Assembly Special Session goals.”

1. For information on a nutritionally adequate and safe diet, see: WHO. Guiding principles for feeding non-breastfed infants 6-24 months. Geneva, 2005.

2. See: WHO. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants in resource-limited settings. Geneva, 2006; WHO. The World Health Report: Make every mother and child count. Geneva, 2005.

3  See: http://www.who.int/child-adolescent-health/NUTRITION/HIV_infant.htm.

Photos: Aurelio Ayala III; 2005 Paul J. Crystal, Courtesy of Photoshare