Research is urgently needed to provide clear recommendations on breastfeeding to mothers with HIV who have an undetectable viral load on antiretroviral treatment, a group of researchers say in the journal The Lancet HIV.
They say that “There is insufficient evidence to state that U=U [undetectable equals untransmittable] in the context of breastfeeding”. Although the risk of transmission is probably small if women have suppressed viral load, the authors highlight a number of research questions that still need to be addressed in order to give evidence-based advice.
In resource-limited settings, the World Health Organization recommends that women with HIV should breastfeed if formula feeding is not safe and feasible and that mothers should receive antiretroviral therapy and infants should receive antiretroviral prophylaxis.
In high-income settings, guidelines have discouraged breastfeeding in women on antiretroviral treatment. However, recent guideline updates by the British HIV Association, the European AIDS Clinical Society and the US Department of Health and Human Services each acknowledge that women with undetectable viral loads may choose to breastfeed, and if they do so, regular viral load and adherence monitoring should take place to minimise the risk of transmission. But the authors of The Lancet HIV review say there is still a lack of evidence to determine how women who breastfeed should be monitored and what risks might remain, despite an undetectable viral load.
The authors of The Lancet HIV paper say that several important research questions still need to be answered to give women the fullest possible information about the risks of breastfeeding, and to determine what package of monitoring and support is necessary during the breastfeeding period.
They highlight questions that still need to be answered.