Pediatric Nutrition in Practice

174 Saloojee  Cooper

nourished HIV-infected infants and children to
ensuring that infected children on ART are well
nourished.
This chapter ref lects this transition, focusing
less on the anthropometric effects and nutrition-
al management of HIV-infected children, and
more on evolving issues in the management of
HIV-exposed infants and the nutritional support
of HIV-infected children and adolescents receiv-
ing ART. Nevertheless, achievement of food and
nutrition security and management of nutrition-
related complications of HIV infection remain
significant challenges in resource-poor environ-
ments.

Feeding the HIV-Exposed Uninfected Infant

Breastfeeding
HIV-positive women living in resource-poor
settings must balance opposing risks – breast
milk can transmit HIV, but lack of breastfeed-
ing increases the risk of infections, malnutrition
and death. In 2010, the WHO revised its posi-
tion by recommending exclusive breastfeeding
(see table  1 for definitions used) for the first 6
months of life followed by complementary
foods and continued breastfeeding through 12
months of age, accompanied by postnatal infant
or maternal antiretroviral prophylaxis [1].

Breastfeeding should only be stopped once nu-

tritionally adequate and safe food intake is as-

sured to the child. Abrupt weaning from breast

milk should be avoided; breastfeeding should

stop gradually over a 1-month period. Mothers

or infants who have been receiving antiretrovi-

ral prophylaxis should continue prophylaxis for

1 week after breastfeeding has been fully stopped

[1]. Maintaining exclusive breastfeeding for 6

months remains a practical challenge in many

settings where early introduction of other foods

or liquids is an established cultural norm. Main-

taining exclusivity may be less important in the

face of concomitant antiretroviral prophylaxis

[2].

Replacement Feeding

In contrast to the WHO, the American Acade-

my of Pediatrics recommends that HIV-infected

mothers not breastfeed their infants, regardless

of maternal disease status, viral load or ART [3].

The British HIV Association and Children’s

HIV Association both concur [4]. Safely pre-

pared exclusive commercial infant formulae can

meet all the nutrient needs of HIV-exposed in-

fants if fed in amounts calculated to meet the

infants’ energy requirements. Women with sus-

pected acute HIV infection, or those not on ART

with low CD4 counts or who have progressed to

AIDS, are encouraged to consider replacement

Ta b l e 1. Definition of commonly used infant feeding terms

Exclusive breastfeeding Receipt of no other substance than human breast milk; medications such as oral
rehydration therapy, antibiotics or multivitamin syrups are permitted; breast milk
can include the mother’s expressed milk or milk from a wet nurse

Replacement feeding Receipt of no breast milk, but of suitable breast milk substitutes in the form of
commercial infant formulae

Mixed feeding Receipt of both breast milk and other liquids or solids, including water and
commercial infant formulae, before the age of 6 months

Complementary feeding Addition of solids, semi-solids and liquids to a breastfeeding diet after the age of
6 months; at this age an infant needs more vitamins, minerals, proteins, fats and
carbohydrates than are available from breast milk alone

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 173–177

DOI: 10.1159/000360332