AKTUALITĀTES
   
87586

Šveice atkal dod drosmīgas rekomendācijas
Apskatīt komentārus (0)


24.08.2018


Šveices zinātnieki nonāca pie secinājuma, ka HIV pozitīvām sievietēm ar nenosakāmu vīrusu slodzi pašām jāpieņem lēmums par to, vai zīdaini barot ar krūti vai ne. Raksts par to bija publicēts zinātniskajā žurnālā Swiss Medical Weekly.
Zinātnieku grupa, kurā ietilpst galveno slimnīcu pediatri un akušieri-ginekologi, kas rūpējas par to cilvēku medicīnisko aprūpi, kuri dzīvo ar HIV Šveicē, veica zinātniskās literatūras apskatu, kas tika publicētas kopš 2009. gada. Gadījumos, kad mātei vīrusu slodze bija mazāka kā 50 kopijas/ml un viņa bija pilnīgi līdzestīga  antiretrovīrusu ārstēšanai, risks, ka bērnam varētu tikt nodots vīruss barojot ar krūti, bija aptuveni 0,3% sešus mēnešus pēc dzemdībām un 0,7% divpadsmit mēnešu pēc dzemdībām.
Tieši tāpēc zinātnieki nonāca pie secinājuma, ka lēmuma, vai barot zīdaini ar krūti, ja mātei ir HIV pozitīvās statuss, sievietei jānonāk patstāvīgi. Bet tikai pēc tam, kad ārsts ir viņu informējis par visiem eksistējošiem riskiem un tajā pašā laikā – par visām krūts barošanas priekšrocībām.
************************
Source: Swiss Medical Weekly | «Is breastfeeding for HIV-positive mothers now recommendable?» | https://smw.ch/en/article/doi/smw.2018.14655/ |
During the last decade mother-to-child transmission (MTCT) of HIV in high-income countries has been virtually eliminated. This success has been achieved with the provision of antiretroviral treatment (ART) to HIV-infected pregnant women, elective caesarean section if the viral load is not successfully suppressed, and the avoidance of breastfeeding. In low-income countries, where breastfeeding is the most common infant feeding practice, very low MTCT rates are also achieved when ART is provided to pregnant and breastfeeding mothers. A recent study from rural Tanzania, in which the viral load of breastfeeding mothers was monitored, found no HIV transmission from virally suppressed mothers to their infants. In view of this, the discussion about whether breastfeeding is an option for mothers living with HIV in high-income countries is now imperative.
In their timely article “Is breastfeeding an equipoise option in effectively treated HIV infected mothers in a high-income setting?” now published in Swiss Medical Weekly, Kahlert et al. suggest that it is time to rethink the hard-line counselling against breastfeeding for HIV-infected mothers in Switzerland and, implicitly, in all Western countries. The authors define a situation which they call “the optimal scenario”: the pregnant woman is adherent in taking her ART, under regular care, and has a suppressed HIV viral load of <50 RNA copies/ml throughout pregnancy and breastfeeding. When these criteria are met, the theoretical risk of MTCT is virtually zero. They argue that this is a situation of clinical equipoise, where the residual risk of MTCT through the breast milk is balanced with the general benefits of breastfeeding, and propose a shared decision-making process to choose the form of infant feeding.
Women living with HIV may desire to breastfeed their infants for several reasons, from promoting bonding with the baby, to cultural, practical or financial reasons. The current categorical advice of abstaining from breastfeeding may preclude women from sharing their feeding preference with providers or cause them to disengage from care because they fear to be judged. Providing a safe space to discuss feeding preferences will certainly contribute to avoid such cases, will promote patient’s autonomy and will allow women to take a well-informed decision.
The article by Kahlert et al. can be very helpful to clinical teams that feel ready to be more flexible with the recommendations they provide to pregnant women living with HIV. In that manuscript they will find a guideline to having a comprehensive discussion with mothers about risks and benefits of breastfeeding and to establish a schedule of clinical and laboratory follow-up of the mother-infant pairs where the mother opts to breastfeed.
An important issue that will need further discussion is whether clinicians should be encouraged to discuss risks and benefits of breastfeeding with all pregnant women meeting the “optimal scenario” or only with those who, besides meeting the “optimal scenario”, verbalise their wish to breastfeed. Discussing breastfeeding with all may lead women who otherwise would not have considered breastfeeding, to do so. On one hand, this may raise a concern of an increase in the transmission risk; on the other hand, keeping the shared decision-making process to only those who express their wish to breastfeed seems paternalistic.
It is time that high-income countries move towards less rigid recommendations about infant feeding. Some families affected with HIV are ready to understand the risks and benefits of breastfeeding their HIV-exposed infants. Therefore, healthcare providers must be able to offer them unbiased information to empower their comprehensive understanding of one or other decision. If, after a shared decision-making process, the mother's choice is supported with a nonjudgmental attitude and close monitoring is arranged, the best care for her and her infant will be guaranteed.




 
      Atpakaļ

atstāj tukšu: atstāj tukšu:
vārds:




Ievadiet drošības kodu:

Visual CAPTCHA



Gaismas iela 19 k-8, Ķekava, Ķekavas pagasts, Ķekavas novads, LV-2123, Latvija

Logo +371 26062077
Logo apvieniba@apvienibahiv.lv