Background: 

Exclusive breastfeeding is recommended for women living with HIV (WLWH) in low-income—but not in high-income—countries, where milk substitutes are preferred. Some guidelines for high-income countries opted for a shared decision-making process regarding breastfeeding in optimal scenarios with adherence to antiretroviral therapy (cART), suppressed maternal viral load (mVL), and clinical monitoring. Although vertical transmission (VT) risk under cART is estimated below 1% in low-income settings, data from high-income countries are rare.

Methods: 

We retrospectively analyzed all 181 live births from WLWH at the LMU Munich university hospital perinatal center in Germany between January 2016 and December 2020. We focused on VT, suppressed mVL and optimal scenario rates, breastfeeding frequency, cART regimens, and infant prophylaxis. All women were counseled according to current guidelines, foremost recommending avoidance of breastfeeding.

Results: 

In the 5-year cohort, no VT was observed. One hundred fifty-one WLWH (83.4%) decided not to breastfeed, even in optimal scenarios. Thrity infants (16.6%) were nursed, of which 25 were within an optimal scenario, whereas in 5 cases, breastfeeding was performed with a detectable VL in pregnancy or the postpartum period. All WLWH were treated with cART at delivery, and 91.7% sustained suppressed mVL. Zidovudine infant prophylaxis was given between 2 and 8 weeks but not necessarily over the whole breastfeeding duration and was declined from 5 breastfeeding WLWH.

Conclusions: 

Although the cohort is too small to assess VT risk through breastfeeding with cART-suppressed mVL, breastfeeding might be an alternative even in high-income countries, but further studies are needed.

中文翻译：

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简要报告：高收入环境中的 HIV 阳性和母乳喂养：德国围产中心的 5 年经验

背景： 

在低收入国家（而非高收入国家）建议感染 HIV 的女性 (WLWH) 进行纯母乳喂养，因为在这些国家更喜欢代乳品。一些针对高收入国家的指南选择了关于在坚持抗逆转录病毒疗法 (cART)、抑制母体病毒载量 (mVL) 和临床监测的最佳情况下进行母乳喂养的共同决策过程。尽管在低收入环境中 cART 下的垂直传播 (VT) 风险估计低于 1%，但来自高收入国家的数据很少。

方法： 

我们回顾性分析了 2016 年 1 月至 2020 年 12 月德国慕尼黑大学医院围产中心的所有 181 例 WLWH 活产。我们重点关注 VT、抑制 mVL 和最佳情景率、母乳喂养频率、cART 方案和婴儿预防。根据现行指南向所有妇女提供咨询，最重要的是建议避免母乳喂养。

结果： 

在 5 年队列中，未观察到 VT。151 名 WLWH (83.4%) 决定不进行母乳喂养，即使在最佳情况下也是如此。3 例婴儿 (16.6%) 接受了护理，其中 25 例在最佳情况下，而在 5 例中，母乳喂养是在妊娠期或产后可检测到 VL 的情况下进行的。所有 WLWH 在分娩时都接受了 cART 治疗，91.7% 的患者 mVL 持续受到抑制。齐多夫定婴儿预防用药在 2 到 8 周之间进行，但不一定在整个母乳喂养期间进行，并且从 5 次母乳喂养 WLWH 开始减少。

结论： 

尽管队列太小而无法通过 cART 抑制的 mVL 进行母乳喂养来评估 VT 风险，但即使在高收入国家，母乳喂养也可能是一种替代方法，但还需要进一步研究。