title: Challenges in infant and young child nutrition in the context of HIV.
abstract: There is consensus on the benefits for all infants of exclusive breastfeeding for 6 months and introduction of appropriate complementary foods at 6 months, followed by continued breastfeeding. However, guidelines on infant and young child feeding (IYCF) for HIV-positive mothers have changed continually since 2000. This article explores issues and evidence related to IYCF for the prevention and care of paediatric HIV in resource-limited settings in light of new HIV treatment guidelines, implementation challenges and knowledge gaps.In 2010 the impact of antiretroviral drugs (ARVs) on reducing the risk of mother-to-child transmission of HIV moved WHO to urge countries to endorse either avoidance of all breastfeeding or exclusive breastfeeding for the first 6 months while taking ARVs, depending on which strategy could give their infants the greatest chance of HIV-free survival. Implementation of the 2010 recommendations is challenged by lack of healthcare provider training, weak clinic-community linkages to support mother/infant pairs and lack of national monitoring and reporting on infant feeding indicators.More evidence is needed to inform prevention and treatment of malnutrition among HIV-exposed and HIV-infected children. Knowledge gaps include the effects of prolonged ARV exposure, the cause of HIV-associated growth faltering, the effects of early infant testing on continuation of breastfeeding and specific nutrition interventions needed for HIV-infected children.Significant progress has been made toward keeping mothers alive and reducing paediatric HIV infection, but sustained political, financial and scientific commitment are required to ensure meaningful interventions to eliminate postnatal transmission and meet the nutritional needs of HIV-exposed and HIV-infected children.
authors.affiliation: aNutrition Section, Program Division, UNICEF, New York, New York bElizabeth Glaser Pediatric AIDS Foundation (EGPAF) cFANTA/ FHI 360 dBaylor International Pediatrics AIDS Initiative (BIPAI) eStrategic Information, Catholic Medical Mission Board (CMMB) fDivision of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia gDepartment of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva hOffice of HIV/AIDS, USAID iGlobal AIDS Program, Health Resources and Services Administration (HRSA), Rockville, MD.
authors.forename: Tin Tin
authors.initials: TT
authors.lastname: Sint
authors.forename: Ronnie
authors.initials: R
authors.lastname: Lovich
authors.forename: Wendy
authors.initials: W
authors.lastname: Hammond
authors.forename: Maria
authors.initials: M
authors.lastname: Kim
authors.forename: Sara
authors.initials: S
authors.lastname: Melillo
authors.forename: Lydia
authors.initials: L
authors.lastname: Lu
authors.forename: Pamela
authors.initials: P
authors.lastname: Ching
authors.forename: Jennifer
authors.initials: J
authors.lastname: Marcy
authors.forename: Nigel
authors.initials: N
authors.lastname: Rollins
authors.forename: Emilia H
authors.initials: EH
authors.lastname: Koumans
authors.forename: Amie N
authors.initials: AN
authors.lastname: Heap
authors.forename: Margaret
authors.initials: M
authors.lastname: Brewinski-Isaacs
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D001903:Bottle Feeding; D001942:Breast Feeding; D015362:Child Nutrition Disorders / Q000517:prevention & control*; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D000075202:Contraindications; D019317:Evidence-Based Medicine; D005247:Feeding Behavior; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission*; D006679:HIV Seropositivity / Q000175:diagnosis / Q000276:immunology; D006284:Health Plan Implementation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009752:Nutritional Status; D011181:Postnatal Care / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018570:Risk Assessment; D014886:Weaning
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents