Khan Sarah, Tsang Kara K, Brophy Jason, Kakkar Fatima, Kennedy V Logan, Boucoiran Isabelle, Yudin Mark H, Money Deborah, Read Stanley, Bitnun Ari
McMaster Children's Hospital, Division of Infectious Diseases, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
J Assoc Med Microbiol Infect Dis Can. 2023 Mar 1;8(1):7-17. doi: 10.3138/jammi-2022-11-03. eCollection 2023 Mar.
Providing comprehensive infant feeding guidance to families affected by HIV is complex and requires a multidisciplinary approach. While exclusive formula feeding remains the preferred recommendation for infants born to women living with HIV (WLWH) in high-income countries, a more nuanced approach that may include the option of breastfeeding under certain circumstances is emerging in many resource-rich countries.
The Canadian Pediatric & Perinatal HIV/AIDS Research Group (CPARG) hosted a Canadian Institute of Health Research-funded meeting in 2016 to develop consensus among multidisciplinary providers around counselling and recommendations for infant feeding. After presentations by adult and paediatric health care providers, basic scientists, and community-based researchers, a subgroup drafted summary evidence-informed recommendations. Along with revisions among CPARG members, a community review was performed by a convenience sample of WLWH who had given birth in the past 5 years from Ontario and Quebec. A legal review was also conducted to ensure understanding of the criminalization potential and concern of HIV transmission and exposure.
The Canadian consensus guidelines continue to support formula feeding as the preferred method of infant feeding as it eliminates any residual risk of postnatal vertical transmission. Formula should be made available for all infants born to mothers living with HIV for their first year of life. A comprehensive approach to counselling WLWH is outlined to assist providers to effectively counsel on current evidence to ensure WLWH are fully informed in their decision making. For women meeting criteria to and elect to breastfeed, frequent maternal virologic monitoring and follow-up is required of both mother and infant. Antiretroviral prophylaxis and monitoring are recommended for breastfed infants. The community review highlighted the importance of other supports and counselling needed for implementing effective formula feeding, aside from access to formula. The legal review provided clarifying language around child protection services involvement and the need to provide referral to legal resources or information upon request. Surveillance systems to monitor for cases of breastmilk transmission should be in place to improve gaps in care and develop further knowledge in this area.
The Canadian infant feeding consensus guideline is designed to inform and enable better care for WLWH and their babies. Ongoing evaluation of these guidelines as new evidence emerges will be important.
为受艾滋病毒影响的家庭提供全面的婴儿喂养指导非常复杂，需要多学科方法。在高收入国家，对于感染艾滋病毒的女性（WLWH）所生婴儿，纯配方奶喂养仍是首选建议，但在许多资源丰富的国家，一种更细致入微的方法正在出现，这种方法在某些情况下可能包括母乳喂养的选择。
加拿大儿科学与围产期艾滋病毒/艾滋病研究小组（CPARG）于2016年主办了一次由加拿大卫生研究院资助的会议，以围绕婴儿喂养的咨询和建议在多学科提供者之间达成共识。在成人和儿科医疗保健提供者、基础科学家以及社区研究人员进行陈述之后，一个小组起草了基于证据的总结建议。除了CPARG成员之间的修订之外，还由安大略省和魁北克省过去5年内分娩的WLWH的便利样本进行了社区审查。还进行了法律审查，以确保了解将艾滋病毒传播和暴露定罪的可能性及相关问题。
加拿大的共识指南继续支持配方奶喂养作为婴儿喂养的首选方法，因为它消除了产后垂直传播的任何残余风险。应为所有感染艾滋病毒的母亲所生婴儿在其出生后的第一年提供配方奶。概述了一种针对WLWH的全面咨询方法，以帮助提供者根据当前证据进行有效咨询，确保WLWH在决策时充分知情。对于符合标准并选择母乳喂养的女性，母亲和婴儿都需要进行频繁的病毒学监测和随访。建议对母乳喂养的婴儿进行抗逆转录病毒预防和监测。社区审查强调了除了获得配方奶之外，实施有效配方奶喂养所需的其他支持和咨询的重要性。法律审查提供了关于儿童保护服务介入的明确措辞，以及根据要求提供转介到法律资源或信息的必要性。应建立监测母乳传播病例的监测系统，以改善护理方面的差距并在该领域获取更多知识。
加拿大婴儿喂养共识指南旨在为WLWH及其婴儿提供信息并实现更好的护理。随着新证据的出现，对这些指南进行持续评估将很重要。
