This is a compilation of recommendations for feeding of HIV-exposed infants based on WHO-UNICEF and the DOH Administrative Order. Ideally, patient's choice should still be considered whether exclusively breastfeeding or exclusively replacement feeding.

1. HIV AND INFANT FEEDING
Helen V. Madamba, MD MPH-TM FPOGS FPIDSOG
HIV/AIDS Core Team (HACT) Orientation for Private and Public Hospitals
Northwinds Hotel, Salinas Drive, Cebu City
13-14 March 2018

2. OBJECTIVES
• To discuss recommendations for
feeding of HIV-exposed infants
• To discuss alternatives for infant
feeding for HIV-exposed infants

3. For the mother living with HIV
• Simple message to communities
“once ARV started, it is
taken for life.”
POGS Clinical Practice Recommendations on PMTCT

4. For the HIV-exposed infant
ARV should be initiated at
birth until tested HIV
negative.
POGS Clinical Practice Recommendations on PMTCT

5. Infant Feeding
INFORMED CONSENT
NO MIXED FEEDING
EXCLUSIVE breastfeeding
or
AFASS replacement feeding

6. Infant Feeding
• continuing ARV medications
• replacement feeding: acceptable,
feasible, affordable, sustainable
and safe (AFASS)
• risks, follow up and other options for
replacement feeding
• relieve breast engorgement
POGS Clinical Practice Recommendations on PMTCT

7. 2016 WHO
recommendations
on HIV and Infant
Feeding
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.

8. Duration of Breastfeeding
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.

9. Support Infant Feeding Practices
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.

10. Mixed Feeding
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.

11. Mixed Feeding
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.

12. 2010 WHO Recommendations Updated
Deciding on Infant Feeding
• Ensuring mothers receive the care they need
Mothers known to be living with HIV should be
provided with lifelong ART or ARV drug
prophylaxis interventions to reduce HIV
transmission through breastfeeding in
accordance with WHO recommendations.
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.

13. Deciding on Infant Feeding
• Mothers known to be living with HIV (and whose
infants are HIV uninfected or of unknown HIV
status) should exclusively breastfeed their infants
for the first six months of life, introducing
appropriate complementary foods thereafter and
continue breastfeeding for the first 12 months of
life.
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.
• Breastfeeding should then only stop once a
nutritionally adequate and safe diet without breast
milk can be provided.

14. When mothers stop breastfeeding
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.
For infants younger than six (6) months
• Wet Nursing – the HIV status of the wet
nurse must be known and should be HIV
negative before wet nursing is initiated
• Expressing and heat treating of
breastmilk
• Breastmilk from milk bank
• Commercial milk formula if the home
conditions outlined below can be fulfilled

15. When mothers stop breastfeeding
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.
For infants older than six (6) months
• Commercial infant formula milk if the home
conditions outlined below can be fulfilled;
• Animal milk (boiled for infants under 12
months) - as part of a diet providing adequate
micronutrient intake; meals, including milk-
only feeds, other foods and combination of
milk feeds and other foods, should be
provided four or five times per day.

16. When mothers opt for milk formula
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.

17. When mothers stop breastfeeding
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.

18. When infant is living with HIV
HVMADAMBA2018
World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of
breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva:
World Health Organization; 2016.
Exclusively breastfeed and continue
breastfeeding up to two years or beyond.

20. Infant Feeding for HIV-exposed or HIV-positive infants
HVMADAMBA2018
1. Mothers living with HIV are strongly
recommended to exclusively
breastfeed their infant in the first 6
months of life. Thereafter,
complementary foods must be
introduced and may continue
breastfeeding for up to 24 months or
longer while being fully supported for
ART adherence.

21. Infant Feeding for HIV-exposed or HIV-positive infants
HVMADAMBA2018
2. Breastfeeding should then only stop
once a nutritionally adequate and safe
diet without breastmilk can be
provided.

22. Feeding of HIV-Exposed Infants
INFORMED CONSENT
NO MIXED FEEDING
EXCLUSIVE breastfeeding
or
AFASS replacement feeding

23. HIV AND INFANT FEEDING
Helen V. Madamba, MD MPH-TM FPOGS FPIDSOG
HIV/AIDS Core Team (HACT) Orientation for Private and Public Hospitals
Northwinds Hotel, Salinas Drive, Cebu City
13-14 March 2018