WHO Guidelines for PMTCT & Breastfeeding

back to top Introduction

In July 2010, the World Health Organization (WHO) issued new HIV and AIDS guidelines on treatment for PMTCT (preventing mother-to-child transmission) and on HIV and breastfeeding - intended primarily for use in low-and middle-income countries, or resource-poor settings.¹ Both the treatment and infant-feeding 2010 guidelines contained major differences compared with previous guidance issued in 2006.

2006 guidelines recommended that only women with a low CD4 count should receive a combination of HIV and AIDS drugs to prevent mother-to-child transmission and all HIV-positive mothers were advised to exclusively breastfeed for 6 months and then rapidly wean to avoid transmitting HIV to their infant.²

New 2010 guidelines, recommended that all HIV-positive mothers, identified during pregnancy, should receive a course of antiretroviral drugs to prevent mother-to-child transmission; two treatment options were recommended under the 2010 guidelines- Option A and Option B. All infants born to HIV-positive mothers should also receive a course of antiretroviral drugs and should be exclusively breastfed for 6 months and complementary fed for up to a year.

Supplementary 2012 guidelines. In 2012, the World Health Organization released a programmatic update to the 2010 HIV and AIDS guidelines on PMTCT.³ The update outlined a third additional option for preventing mother-to-child transmission of HIV - Option B+. This approach is similar to Option B, but suggests giving the mother triple ARVs as soon as they are diagnosed, continuing for life, regardless of CD4 count. The Option B+ approach has a number of advantages, discussed in more detail on AVERT's 'Prevention of Mother-to-child Transmission (PMTCT)' page.

For infant feeding, where resources are limited, health providers are recommended to continue using the 2006 guidelines.⁴ For more details about the 2006 guidelines, please see AVERT’s breastfeeding and HIV page.

The decision to adopt either the Option A, B or B+ approach should be made at a country level.

back to top Summary of WHO PMTCT and Breastfeeding Guidelines 2010 (Option A and B)

The following information covers Option A and Option B PMTCT approaches. See below for details about the third PMTCT approach, Option B+, recommended by the WHO in April 2012 .

Mothers, when identified in pregnancy as being HIV positive, should have a CD4 test to determine whether they need to take medication for their own health or solely for the purpose of preventing HIV transmission to their unborn infant. If their CD4 count is below or equal to 350 cells/mm³ they need to start taking antiretroviral drugs for their own health. If a woman has a CD4 count higher than 350 cells/mm³ then they do not need to take medication for their own health. However, they will need to take medication to prevent HIV transmission to their infant(s).

Mother taking ARVs (antiretroviral drugs) for her own health

Under both Option A and Option B, a mother who has a CD4 count below 350 cells/mm³ should begin taking antiretrovirals for her own health. This should involve a combination of antiretrovirals as soon as diagnosed. This course of medication should be permanent and taken every day in order to postpone the development of HIV into AIDS.

Mother taking ARVs for her infant’s health

A mother who has a CD4 count above 350 cells/mm³ and is taking antiretrovirals for her infant's health will follow one of two treatment options. It is considered that both options have advantages and disadvantages in terms of feasibility, acceptability, cost, and safety for both mother and infant. The choice for a preferred option should be made at a country level.

Option A. Under this PMTCT approach, the mother receives antiretrovirals at three different stages of pregnancy. Antepartum: AZT at 14 weeks gestation. Intrapartum: Single-dose NVP and first dose AZT/3TC at onset of labour. Postpartum: Daily AZT/3TC for 7 days immediately following childbirth.

Option B. Under this PMTCT approach, the mother starts taking a triple antiretroviral regimen at 14 weeks gestation, and continues taking this treatment intrapartum and through childbirth. If the mother is breastfeeding, she should also continue to take the triple antiretroviral regimen until 1 week after breastfeeding has finished.

Infants

All infants born to HIV positive mothers should receive a course of medication for PMTCT, which is linked to the drug regimen that the mother is taking and the infants feeding method.

Option A and Breastfeeding. The infant should receive daily NVP from birth, until 1 week after breastfeeding has finished.

Option A and Not Breastfeeding or mother taking ARVs for her own health. The infant should receive daily NVP from birth until age 4-6 weeks.

Option B and Breastfeeding/ Not Breastfeeding. The infant should receive daily NVP or AZT from birth until age 4-6 weeks.

A child who is being breastfed should continue to breastfeed for up to 6 months. See: 'HIV and Breastfeeding' for detailed guidance on breastfeeding.

back to top Summary of WHO PMTCT Programmatic Update, April 2012 (Option B+)

Mother

Mothers, when identified in pregnancy as being HIV positive, should begin a triple antiretroviral regimen immediately after being diagnosed, irrespective of their CD4 count. Mothers should remain on the same triple antiretroviral regimen throughout pregnancy and continuing for life.

Infants

Infants born to HIV positive mothers should receive a course of medication for PMTCT. Under Option B+ the infant should receive daily NVP or AZT from birth until age 4-6 weeks, regardless of infant feeding method. 

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Sources back to top

• WHO (2012, April) 'Programmatic update: Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants' - 2012
• WHO (2010) 'Guidelines on HIV and Infant Feeding 2010', Geneva - 2010
• WHO (2010) 'Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: Towards Universal Access', Geneva - 2010

References back to top

1. WHO (2010) 'Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: Towards Universal Access', Geneva
2. WHO (2006) 'Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: Towards Universal Access', Geneva
3. WHO (2012, April) 'Programmatic update: Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants'
4. WHO (2010) 'Guidelines on HIV and Infant Feeding 2010', Geneva