WHO HIV & AIDS Guidelines for PMTCT & Breastfeeding

In July 2010, the World Health Organization (WHO) issued new HIV and AIDS guidelines on PMTCT (preventing mother to child transmission) and on HIV and breastfeeding.¹ For both PMTCT and for infant feeding there are major differences between these 2010 recommendations and the previous guidance issued in 2006.

Under the 2010 guidelines, all HIV positive mothers, identified during pregnancy, should receive a course of antiretroviral drugs to prevent mother to child transmission. All infants born to HIV positive mothers should also receive a course of antiretroviral drugs and should be exclusively breastfed for 6 months and complementary fed for up to a year.

Previous guidelines, issued in 2006, recommended that only women with a low CD4 count should receive a combination of HIV and AIDS drugs to prevent mother to child transmission and all HIV positive mothers were advised to exclusively breastfeed for 6 months and then rapidly wean to avoid transmitting HIV to their infant.²

For infant feeding, where resources are limited, health providers are recommended to continue using the 2006 guidelines.³ For more details about the 2006 guidelines, please see AVERT’s breastfeeding and HIV page.

back to top Summary of WHO PMTCT and breastfeeding Guidelines 2010

Details of the WHO PMTCT and breastfeeding guidelines

Mothers, when identified in pregnancy as being HIV positive, should have a CD4 test to determine whether they need to take medication for their own health or for their unborn infant’s health. If their CD4 count is below or equal to 350 cells/mm³ they need to start taking antiretroviral drugs for their own health. If a woman has a CD4 count higher than 350 cells/mm³ then they do not need to take medication for their own health. However, they will need to take medication to prevent HIV transmission to their infant(s).

Mother taking ARVs (antiretroviral drugs) for her own health

A mother taking ARVs for her own health should take a combination of ARVs as soon as possible. This course of medication should be permanent and taken every day in order to postpone the development of her illness. In this situation, if an infant is being breastfed they should have daily NVP (nevirapine) for 6 weeks.

Mother taking ARVs for her infant’s health

There should be two drug combination options. The first option, Option A, closely resembles the WHO’s 2006 recommendations and might be a system already in place at country level. However, option B is a simple regimen for health providers and mothers to implement. It is considered that both options have advantages and disadvantages in terms of feasibility, acceptability, cost, and safety for both mother and infant. The choice for a preferred option should be made at a country level.

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. If a mother is permanently taking ARV medication, the infant should receive daily NVP for 6 weeks. If the mother’s medication course is option A, the infant should receive daily NVP until one week after breastfeeding has ended.

If a child is being breastfed then this should be up to 6 months. After this a mother should supplement her breast milk with complementary feeding and all breastfeeding should be stopped by 12 months of life. Mothers are no longer advised to rapidly wean.

If an infant is not breastfeed, they should be given daily NVP or AZT (zidovudine) for 6 weeks.

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References back to top

1. WHO, 2010, 'Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: Towards Universal Access', Geneva
2. WHO, 2006, 'Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: Towards Universal Access', Geneva
3. WHO, 2010, 'Guidelines on HIV and Infant Feeding 2010', Geneva