7. Hiv in breastfeeding [reviewed- 2

HIV IN
BREASTFEEDING
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By Retichiah
PRESENTATION LAY OUT
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Introduction
Definitions
Pathophysiology
Incidence
Risk factors
Challenges and barriers
Public health impact
Strategies and Breastfeeding guidelines
GENERAL OBJECTIVES
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 To explore the key factors influencing HIV

transmission during breastfeeding and to discuss
strategies for effectively promoting breastfeeding
while preventing mother-to-child transmission of
HIV in Zambia.
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SPECIFIC OBJECTIVES
 To review the current prevalence of HIV among women of
reproductive age in Zambia.
 To identify the risk factors associated with mother-to-child
transmission (MTCT) of HIV during breastfeeding.
 To analyze the challenges in promoting breastfeeding among
HIV-positive mothers.
 To evaluate the effectiveness of PMTCT strategies in
reducing HIV transmission during breastfeeding.
 To discuss the impact of breastfeeding and PMTCT
interventions on child survival rates.
Introduction
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HIV is a significant public health concern. As of the

most recent reports, approximately 11.3% if
Zambian woman aged 15-49 are living with HIV
with a prevalence of 12-14% within the age group.
Public health sector faces challenges in promoting
breastfeeding especially if the mother is not
adherent to ART.
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Pathophysiology
HIV in breastfeeding pathophysiology refers to how the human

immunodeficiency virus (HIV) can be transmitted from an HIV-
positive mother to her child through breast milk and the
biological mechanisms underlying this transmission.
 HIV Presence in Breast Milk: HIV is found in both the cellular
and acellular components of breast milk. The virus can exist
in free form or within infected cells (like macrophages or
lymphocytes) present in breast milk.
 Mechanism of Transmission:
Continuation…..
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 Free virus in milk: HIV particles in the milk can directly infect
the infant’s mucosal surfaces (mainly the gastrointestinal tract)
during breastfeeding.
 Infected cells in milk: Some immune cells present in the breast
milk of HIV-positive mothers are infected with the virus,
potentially passing the infection to the infant.
 Infant Gastrointestinal Vulnerability: The infant's gastrointestinal
tract is not fully developed, making it more susceptible to HIV
infection. The mucosal barriers in infants are relatively
immature and allow easier viral penetration compared to adults.
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Increased maternal RNA viral load in plasma and breast milk

is strongly associated with increased risk of transmission
through breastfeeding. High levels of virus in plasma and
probably also in breast milk, are seen in primary HIV infection,
when the rate of postnatal transmission has been estimated
to be nearly 30%. Late postnatal transmission risk is around
1% per month of breastfeeding and is constant over time from
between four and six weeks to 18 months. Transmission can
occur at any point during Breastfeeding hence the longer the
duration of breastfeeding the greater the cumulative risk.
Definitions
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HIV: Human immunodeficiency virus, is a virus that attacks the
body's immune system, specifically the CD4 cells (T cells),
which are vital for immune defense.
PMTCT: (Prevention of mother to child transmission) refers to
interventions aimed at preventing the transmission of HIV from
an HIV-positive mother to her child during pregnancy, childbirth,
or breastfeeding.
ART: (Antiretroviral therapy) refers to the use of a combination
of antiretroviral drugs to treat HIV infection. These drugs do not
cure HIV but work to suppress the virus, reducing its presence
in the body to undetectable levels.
Continuation.…..
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 AIDS (Acquired Immunodeficiency Syndrome): AIDS is

the most advanced stage of HIV infection. It occurs
when the HIV virus has severely weakened the
immune system, making the body more vulnerable to
opportunistic infections and certain cancers.
 Exclusive Breastfeeding: feeding an infant only breast
milk for the first six months.
 Mixed feeding: Combining breast milk with other foods
or liquids.
Risk factors for transmission
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Maternal
 Breast milk loaded with virus coming from the mothers’
system
 Breast infections ( mastitis, abscess, bleeding nipples) in a
positive mother with high viral load
 Co- infection (STI) likelihood of HIV virus to be in the
mothers system
 Poor maternal health ( malnutrition, anemia, chronic illness)
weaken the immunity risk of contracting the virus
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Continuation…….
Obstetric
 Mode of delivery, vaginal delivery has higher risk of
transmission than elective c-s which can be
recommended at times in a positive mother
 Prolonged rupture of membranes which increases the
time of exposure of the fetus in HIV infected fluids.
 Invasive procedures like amniocentesis, forceps
delivery and episiotomy.
Infant
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 Breastfeeding duration, beyond the recommended 6mts period

increases the risk if the mother is not adherent to ART
 Mouth or intestine lesions
 Prematurity
 Mixed feeding which can cause damage to the infant gut lining
 Lack of safe alternatives in cases to breast milk( e.g formula

milk) are not available or feasible, mothers can continue
breastfeeding which increases the risk of transmission.
Challenges
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and Barriers
Health care systems
 Inconsistent access to ART and PMTCT services especially
in rural areas and inconsistent monitoring of viral load.
 Limited health care resources and infrastructure to support
continuous education and follow up for HIV positive mothers.
Cultural and social
 Stigma surrounding HIV infected mothers may prevent
mothers from seeking ART or adhering to medical advice.
 Misinformation/ lack of knowledge about HIV and
breastfeeding poses as a significant challenge.
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Continuation….
 Poverty and lack of resources: limited access to
health care services, ART and safe alternatives to
Breastfeeding due to poverty can hinder effective
PMTCT
 Cultural practices: certain beliefs and practices may
discourage the use of ART, promote mixed feeding or
delay healthcare seeking behavior thereby
increasing transmission risk.
Impact on public health and child survival rates
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Public health implication

High rates of HIV transmission through breastfeeding
can undermine public health efforts to reduce child
mortality and improve maternal Health.
 Ensuring HIV positive mothers adhere to ART and
follow breastfeeding guidelines is crucial to reducing
MTCT rates.
Child survival rates
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 Effective PMTCT programs, including safe
breastfeeding practices can significantly lower the
risk of HIV transmission, thereby improving survival
rates of children born to HIV positive mothers.
 In absence of proper interventions, the risk of HIV
transmission through breastfeeding can contribute
to higher infant mortality rates.
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. BREASTFEEDING GUILDLINES
Mothers known to be HIV infected ( and whose
infants are HIV uninfected or of unknown HIV
status ) should exclusively breastfeed their infants
for the first 6 months of life, introducing
appropriate complementary foods thereafter and
continue breastfeeding .
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Continuation…..
Initially, they should receive complementary foods 2-3 times a day
between 6-8 months and increase to 3-4 times daily between 9-11
months and 12-24 months
When families have access to feasible feeds they can discontinue
breastfeeding.
HOW TO DECIDE?
What is meant by Acceptable?
The mother perceives no significant barrier to replacement feeding e.g.
cultural or social stigmas. She can use the feeding method without undue
z Continuation……
What is meant by Feasible?

The mother had the resources, time and ability to prepare and
administer replacement feeding without difficulty. This includes
access to clean water and the means to prepare formula safely.
What is meant by Sustainable?
The mother can maintain the chosen feeding practice
consistently overtime, ensuring a reliable supply of formula and
other necessary resources to sustain the feeding method.
What isz meant by safe?
The replacement feeding method minimizes health
risks such as infections. This requires access to clean
water, hygiene practices and safe storage and
preparation of formula.
These criteria help guide decisions on whether
replacement feeding can be a suitable alternative to
Breastfeeding, balancing the need to prevent HIV
transmission with ensuring that the infants nutrition
and safety are prioritized.
Conclusion
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The importance of balancing the benefits of
breastfeeding with the risks of HIV transmission and the
critical role of ART in enabling HIV positive mothers to
breastfeed safely.
Looking ahead, strengthening healthcare systems to
support HIV positive mothers and the need for ongoing
research and education to improve outcomes.
Encourage collaboration between healthcare providers,
policy makers and communities to address the
challenges of HIV in breastfeeding.
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REFERENCE
 https://www.tht.org.uk>Parenthood
 Https://www.who.int>interventions (9 Aug 2023)
 https://iris.who.int>bitstream
 GUIDELINE: UPDATE ON HIV AND INFANT FEEDING (WHO with UNICEF)
2016
 Zambia’s ministry of Health reports and publications.
 Peer reviewed journal articles on HIV and breastfeeding.
 World Health Organization (WHO). (2023). HIV/AIDS. This source provides
comprehensive definitions and information on HIV, AIDS, and ART.
 Centers for Disease Control and Prevention (CDC). (2022). HIV Treatment:
ART.
Additional information
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Classes of Antiretroviral Drugs:
 NRTIs (Nucleoside Reverse Transcriptase Inhibitors)
 NNRTIs (Non-Nucleoside Reverse Transcriptase Inhibitors)
 PIs (Protease Inhibitors)
 INSTIs (Integrase Strand Transfer Inhibitors)
 Entry or Fusion Inhibitors

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HIV IN

 To explore the key factors influencing HIV

HIV is a significant public health concern. As of the

HIV in breastfeeding pathophysiology refers to how the human

Increased maternal RNA viral load in plasma and breast milk

 AIDS (Acquired Immunodeficiency Syndrome): AIDS is

 Breastfeeding duration, beyond the recommended 6mts period

 Lack of safe alternatives in cases to breast milk( e.g formula

Public health implication

What is meant by Feasible?

Classes of Antiretroviral Drugs:

 NRTIs (Nucleoside Reverse Transcriptase Inhibitors)

 NNRTIs (Non-Nucleoside Reverse Transcriptase Inhibitors)

 PIs (Protease Inhibitors)

 INSTIs (Integrase Strand Transfer Inhibitors)

 Entry or Fusion Inhibitors

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