Breastfeeding Among People With Human Immunodeficiency Virus in North America: A Multisite Study

Judy Levison, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
Jennifer McKinney, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA.
Alejandra Duque, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
Joanna Hawkins, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
Emily Ver Bowden, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
Julie Dorland, Department of Obstetrics and Gynecology, University of Texas at Austin Dell Medical School, Austin, Texas, USA.
Ari Bitnun, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada.
Kescha Kazmi, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada.
Douglas M. Campbell, Department of Pediatrics, University of Toronto, St. Michael's Hospital, Toronto, Canada.
Jay MacGillivray, Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada.
Mark H. Yudin, Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada.
Anna Powell, Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Shreetoma Datta, Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Lisa Abuogi, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA.
Adriana Weinberg, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA.
Natella Rakhmanina, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Joanna Walsh Mareuil, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Jane Hitti, Department of Maternal Fetal Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Isabelle Boucoiran, Department of Obstetrics and Gynecology, University of Montreal/Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.
Fatima Kakkar, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.
Lisa Rahangdale, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Dominika Seidman, Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, USA.
Rebecca Widener, Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina, USA.

Document Type

Journal Article

Publication Date

11-17-2023

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Volume

77

Issue

10

DOI

10.1093/cid/ciad235

Keywords

HIV; breastfeeding; institutional practices; prenatal care

Abstract

BACKGROUND: In North American countries, national guidelines have strongly recommended formula over breastmilk for people with human immunodeficiency virus (HIV) because of concern for HIV transmission. However, data from resource-limited settings suggest the risk is <1% among virally suppressed people. Information regarding breastfeeding experience in high-resource settings is lacking. METHODS: A retrospective multisite study was performed for individuals with HIV who breastfed during 2014-2022 in the United States (8 sites) and Canada (3 sites). Descriptive statistics were used for data analysis. RESULTS: Among the 72 cases reported, most had been diagnosed with HIV and were on antiretroviral therapy prior to the index pregnancy and had undetectable viral loads at delivery. Most commonly reported reasons for choosing to breastfeed were health benefits, community expectations, and parent-child bonding. Median duration of breastfeeding was 24 weeks (range, 1 day to 72 weeks). Regimens for infant prophylaxis and protocols for testing of infants and birthing parents varied widely among institutions. No neonatal transmissions occurred among the 94% of infants for whom results were available ≥6 weeks after weaning. CONCLUSIONS: This study describes the largest cohort to date of people with HIV who breastfed in North America. Findings demonstrate high variability among institutions in policies, infant prophylaxis, and infant and parental testing practices. The study describes challenges in weighing the potential risks of transmission with personal and community factors. Finally, this study highlights the relatively small numbers of patients with HIV who chose to breastfeed at any 1 location, and the need for further multisite studies to identify best care practices.

Department

Pediatrics

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