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. 2021 Jul 13;17(4):e13244. doi: 10.1111/mcn.13244
Guideline Woman's antiretroviral recommendation Infant antiretroviral recommendation Infant feeding recommendation
(WHO Global Programme on AIDS & UNICEF, 1992) Consensus statement from the WHO/UNICEF Consultation on HIV Transmission and Breast‐Feeding, Geneva, 30 April ‐ 1 May 1992 Not mentioned Not mentioned

• Breastfeed regardless of status.

• In settings with greater risk of infant death due to infectious disease and malnutrition, breastfeeding is advised.

UNICEF et al. (1998) A review of HIV transmission through breastfeeding. UNICEF‐UNAIDS‐WHO. HIV and infant feeding. Nil recommendation, but discussed trials of antiretroviral regimens and their effectiveness, due to trials ongoing. Antiretroviral prophylaxis postnatally

• Replacement feeding if possible.

• If breastfeeding, early cessation as early as possible, or expressed breast milk or wet nursing from a tested HIV negative woman.

WHO (2001) New Data on the Prevention of Mother‐to‐Child Transmission of HIV and their Policy Implications. To have antiretroviral prophylaxis regimen (ZDV, ZDV + 3TC or nevirapine) as per local policy

To have antiretroviral regimen as per local policy

• Replacement feeding if AFASS (Acceptable, Feasible, Affordable, Sustainable, Safe) criteria met

• Exclusive breastfeeding for 6 months with rapid weaning and replacement feeding

WHO et al. (2007) HIV and Infant Feeding. Update based on the Technical Consultation held on behalf of the Inter‐agency Task Team (IATT) on Prevention of HIV Infection in Pregnant Women, Mothers and their Infants. Geneva, 25–27 October 2006 Antiretroviral therapy for women's health or 7 day prophylaxis postpartum Prophylaxis for 7 days post‐birth

• Exclusive breastfeeding for first 6 months if AFASS criteria not met

• Breastfeeding cessation at 6 months if infant's diet is adequate

• Complementary feeding from 6 months if AFASS criteria not met

• Weaning over 2–3 days or up to 2–3 weeks maximum

• Rapid weaning is not recommended

WHO (2010) Guidelines on HIV and infant feeding. 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. Lifelong antiretroviral therapy or antiretroviral prophylaxis throughout pregnancy until 1 week post finishing breastfeeding Daily antiretroviral prophylaxis if woman is not on treatment, lasting until 1–2 weeks post finishing breastfeeding or 4–6 weeks if women is on antiretroviral treatment

• Exclusive breastfeeding until 12 months

• Complementary feeding from 6 months

• Wean over one month.

WHO (2013) Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. June 2013.

Option B: Lifelong ART for pregnant and breastfeeding women eligible for treatment (CD4 count ≤350 cells/mm3)

Option B+: Lifelong ART regardless of CD4 cell count.

If infant is breastfeeding: antiretroviral prophylaxis (nevirapine) once a day from birth for 6 weeks

If infant is replacement feeding: Prophylaxis NVP once daily or AZT twice daily for 4–6 weeks

• Exclusive breastfeeding until 12 months if adequate diet available

• Complementary feeding from 6 months

• Wean over one month period

WHO and UNICEF (2016) 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. Option B+ Infant receives daily NVP or AZT for 4–6 weeks

• Exclusively breastfeed for 6 months

• Complementary feeding from 6 months while continuing breastfeeding for up to 24 months and beyond

• One month weaning period