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WHO Guidelines for PMTCT & Breastfeeding

A pregnant women accesses antenatal care, in India

Introduction

In July 2013, the World Health Organization (WHO) issued new HIV and AIDS guidelines on treatment for PMTCT (preventing mother-to-child transmission) and on HIV and breastfeeding - intended primarily for use in low-and middle-income countries, or resource-poor settings.

The treatment and infant-feeding 2013 guidelines brought clarity around treatment recommendations, leaning clearly towards placing pregnant women with HIV on treatment for life.

Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants

Pregnant and breastfeeding women

2013 guidelines recommend that countries follow option B+ and in countries where this is not feasible, option B. Option A (2006 guidelines) is now only cited as a last resort.

Option B+

Provide all HIV-positive pregnant or breastfeeding women with a course of antiretroviral drugs to prevent mother-to-child transmission. A triple-drug antiretroviral regimen should be taken throughout pregnancy, delivery and breastfeeding - continuing for life, regardless of CD4 count or clinical stage.

Option B

Provide all HIV-positive pregnant or breastfeeding women with a course of antiretroviral drugs to prevent mother-to-child transmission. A triple-drug antiretroviral regimen should be taken throughout pregnancy and delivery. If the mother is breastfeeding, she should also continue to take the triple-drug antiretroviral regimen until 1 week after breastfeeding has finished.

Pregnant women who are eligible to receive antiretroviral treatment for their own health, based on their CD4 count or clinical stage, should continue taking HIV treatment for life. Eligibility is determined at a country level. WHO recommends women with a CD4 count of ≤ 500 cells/mm3 (or clinic stage 3 or 4) should continue taking antiretroviral treatment for life. This course of medication should be permanent and taken every day in order to postpone the development of HIV into AIDS.

HIV-exposed infants

All infants born to HIV positive mothers should receive a course of medication for PMTCT, which is linked to the drug regimen that the mother is taking and the infants feeding method.

Breastfeeding

The infant should receive once-daily NVP from birth until age 6 weeks.

Not breastfeeding

The infant should receive once-daily NVP (or twice-daily AZT) from birth until age 4–6 weeks.

A child who is being breastfed should continue to breastfeed for up to 6 months, with complementary feed between 6 months and 1 year. See: 'HIV and Breastfeeding' for detailed guidance on breastfeeding.

PMTCT flow diagram

PMTCT flow diagram

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