WHO now recommends the use of postpartum antiretroviral therapy, either maternal HAART or infant nevirapine treatment, to reduce the risk of HIV transmission during the period of breast feeding. As the WHO guidelines are not generally applicable to the UK setting, BHIVA/CHIVA have reviewed the data with a view to providing guidance both to people living with HIV and to healthcare providers with regard to the safety of different feeding practices and the related safeguarding Crizotinib issues. The summary guidance presented below takes into account the substantial number of responses to a public consultation on an earlier draft of this advice, incorporating diverse and often

conflicting views and data interpretations. The Writing Group reconvened Akt inhibitor to address these issues, particularly the concerns expressed by many that any new recommendations should not undermine the extensive and highly successful work to reduce mother-to-child transmission of HIV by complete avoidance of breast feeding. With current interventions, mother-to-child HIV transmission in the UK is now very low, being ∼1% for all

women diagnosed prior to delivery, and 0.1% for women on HAART with a viral load <50 HIV-1 RNA copies/ml plasma [2] at delivery. Current BHIVA/CHIVA pregnancy management guidelines include HAART, the option of managed vaginal delivery for women with an undetectable HIV viral load on HAART at term, pre-labour pre-rupture of membranes caesarean section for women with a detectable viral load, and exclusive feeding with infant formula milk from birth [3]. Mother-to-child HIV transmission can occur through breast feeding, with an ongoing infection risk throughout the breast-feeding period; by contrast, there is no risk of postnatal HIV transmission if the infant is not breastfed [4–6]. The long-term effects of exposing infants to HAART through breast milk are unknown. 1 For these reasons, BHIVA/CHIVA continue

to recommend that, in the UK, mothers known to be HIV-infected, click here regardless of maternal viral load and antiretroviral therapy, refrain from breast feeding from birth. While all other interventions to prevent mother-to-child HIV transmission are provided through HIV commissioned services, it is recognized that infant formula milk is not universally provided and that this lack of provision can be a barrier to the successful implementation of this recommendation. BHIVA/CHIVA therefore recommend that: 2 All HIV-positive mothers in the UK should be supported to formula-feed their infants. This means that: (i) A starter pack (infant formula milk and appropriate equipment) should be freely available as part of the package of care to prevent mother-to-child transmission. 1 Women who are on low incomes and eligible for Healthy Start should be informed about how to purchase infant formula milk with their vouchers (see Appendix 1, which discusses financial support).