为了帮助消除围产期艾滋病毒传播,美国卫生和人类服务部建议不要对感染艾滋病毒的妇女进行母乳喂养,无论病毒载量或联合抗逆转录病毒治疗(cART)状态。然而,cART从根本上改善了HIV预后,几乎消除了围产期传播,和母乳喂养的健康益处是公认的。在此设置中,美国感染艾滋病毒的女性怀孕人数正在增加,并建议尽管进行了广泛的咨询,但仍对母乳喂养的人采取减少伤害的方法。我们评估当前政策的证据和道德理由,关注相关的种族和健康差异。我们首先回顾了与美国婴儿相关的围产期传播和母乳喂养数据。我们比较了从母乳中传播艾滋病毒的假设风险与婴儿猝死综合症增加的死亡率,坏死性小肠结肠炎和败血症避免母乳喂养,发现如果母亲在cART上保持检测不到的病毒载量,益处可能大于风险。然后,我们回顾了孕产妇健康考虑因素。我们得出的结论是,感染艾滋病毒的妇女避免母乳喂养可能无法最大限度地提高健康结果,并讨论了我们根据自主权修订国家指南的建议。减少伤害和健康不平等。
To help eliminate perinatal HIV transmission, the US Department of Health and Human Services recommends against breastfeeding for women living with HIV, regardless of viral load or combined antiretroviral therapy (cART) status. However, cART radically improves HIV prognosis and virtually eliminates perinatal transmission, and breastfeeding\'s health benefits are well-established. In this setting, pregnancy is increasing among American women with HIV, and a harm reduction approach to those who breastfeed despite extensive counseling is suggested. We assess the evidence and ethical justification for current policy, with attention to pertinent racial and health disparities. We first review perinatal transmission and breastfeeding data relevant to US infants. We compare hypothetical risk of HIV transmission from breastmilk to increased mortality from sudden infant death syndrome, necrotizing enterocolitis and sepsis from avoiding breastfeeding, finding that benefits may outweigh risks if mothers maintain undetectable viral load on cART. We then review maternal health considerations. We conclude that avoidance of breastfeeding by women living with HIV may not maximize health outcomes and discuss our recommendation for revising national guidelines in light of autonomy, harm reduction and health inequities.