Towards zero: with Dr. Watiti

Is there an organization that provides free milk?

Q: Dear Doctor,
I am-HIV positive and delivered a week ago. I have been bottle-feeding my baby, but realized the baby formula is expensive and my husband is now telling me I will have to breastfeed the child.

However, I am scared of infecting my baby with the virus. Is there an organisation that helps HIVpositive mothers with baby formula so that they can avoid breastfeeding and infecting their babies?

Mary

A: Dear Mary,
I am not aware of any organisation that offers the kind of help you are looking for. From what you have said, the mode of feeding your baby is neither safe nor sustainable.

Bottle-feeding puts children at high risk of getting diarrhoea and it is not advisable. Your child is also at risk of being malnourished because, most likely, he or she is not getting adequate nutrition, considering the high cost of baby formula. You should breastfeed your baby exclusively for up to six months then introduce other safe foods.

If you are on ARVs, the risk of passing HIV to your baby when you do exclusively breastfeeding is very low. Many of the children born to HIV-positive mothers who are not breastfed die from diarrhea and/or malnutrition.

When deciding how to feed their children, mothers who are HIV-positive should choose a method that is affordable, feasible, acceptable, safe and sustainable. In your case, only breastfeeding can meet all these criteria.

Whose doctor is right?

Q: Dear Doctor,
My sister and I are both HIV-positive and pregnant. Because of that, I was put on ARVs even though my CD4 count was still high at 400 cells/ ml and told that I will have to continue with the drugs even when I deliver the baby.

My sister’s doctor, on the other hand, has told her that since her CD4 count is high, she will not need to be on ARVs after she has delivered the baby, though her baby will be given Nevirapine to take while she continues to breastfeed. We are confused as to what to do.

Jackie

A: Dear Jackie,
What your doctor has told you to do, i.e. continue taking ARVs for life after delivery regardless of your CD4 count, is what is recommended under ideal conditions.

Ideally all HIV-positive pregnant women should be put on ARVs regardless of their CD4 count and they should not stop the drugs even after delivery.

This is what is known as prevention of motherto- child transmission (PMTCT) option B+. However, because of limited funding, this is not possible for all people considering the fact that there are still many people living with HIV with CD4 counts below 350 cells/ml who are not yet on ARVs.

These are at risk of developing serious opportunistic infections unlike those given ARVs for prevention of PMTCT. Your sister should have her CD4 count monitored regularly after delivery, so that she is put on ARVs when her CD4 counts drops to 350 cells/ml or less.

For you, it is okay to continue taking ARVs after delivery so long as you are assured of continued supply of the drugs. The added advantage you have is that being on ARVs reduces your capacity to transmit HIV to others either horizontally to your sexual partner or vertically to your child because your viral load or amount of virus in the blood will be lower compared with another person living with HIV who is not on ARVs.

The writer is a medical officer at Mildmay, Uganda