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Hepatitis B
17%
1/6
Hepatitis C
Latent tuberculosis
0%
0/6
Human Immunodeficiency Virus (HIV)
67%
4/6
All of the above
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Maternal HIV is an absolute contraindication to breastfeeding in the United States. Infants with HIV positive mothers are typically fed with formula. The mother in this vignette is from Sub-Saharan Africa and has an unclear medical history. This should prompt testing for HIV before breastfeeding. If the mother tests positive for HIV, because she will now be residing in the US, breastfeeding is contraindicated. In resource limited countries, mothers may breastfeed as the benefits of non-HIV morbidity and mortality outweigh the risk of mother-child transmission. Other absolute contraindications include: known infection with HTLV-1/2, illicit drug abuse, current treatment with chemotherapy or radiation, and galactosemia in the breastfeeding infant. The Committee on Pediatric Aids discusses HIV transmission through infant feeding in the US. Currently, the rate of mother-to-child transmission during pregnancy is <1% due to HIV prophylaxis measures. Unfortunately, even if RNA viral counts are negligible, the risk of infection through breast milk ranges from 1-5%. Hence, in the US, it's recommended that even if viral counts are undetectable and the patient is on HAART therapy, the mother should not breastfeed. In resource limited countries HIV positive mothers may breastfeed. Siberry discusses methods to prevent and manage HIV in infants. All pregnant women, regardless of past negative tests, should be tested for HIV. Testing should be performed as early as possible in the pregnancy. When a mother is diagnosed with HIV, HAART therapy should be initiated promptly. If viral RNA is >1,000 copies close to time of delivery, the patient schedule a cesarean section. Infants born to HIV positive mothers should be treated with zidovudine starting within 6-12 hours of delivery and continue treatment for 6 weeks. Incorrect answers: Answers 1 and 2: Neither Hepatitis B nor Hepatitis C are transferred through breast milk. Infants born to Hepatitis B positive mothers should be given both Hepatitis B immune globulin and vaccine immediately postpartum. Answer 3: Active tuberculosis, not latent, is an absolute contraindication to breastfeeding. Answer 5: Hepatitis B, Hepatitis C and latent tuberculosis are not contraindications to breast feeding.
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