Human Immunodeficiency Virus (HIV)

In the United States, to prevent HIV transmission, it is recommended that mothers living with HIV not breastfeed their infants.

HIV is a virus that attacks the body’s immune system and is spread through certain body fluids, including breast milk. Perinatal transmission can occur during pregnancy, birth, or breastfeeding. Treatment for HIV (antiretroviral therapy, or ART) substantially reduces the risk of perinatal transmission.

Can HIV be transmitted through breast milk?

Yes. Breastfeeding contributes to the risk of perinatal HIV infection. Although maternal ART substantially reduces the risk of transmission through breast milk, it does not eliminate the risk.

What is the safest way for a mother living with HIV to feed her infant?

Did You Know?

Human milk is the optimal nutrition for very low birthweight (VLBW) infants because it decreases the risk of significant complications of prematurity, most notably, necrotizing enterocolitis. For VLBW infants, pasteurized donor human milk is recommended when mother’s own milk is not available or contraindicated, such as for mothers living with HIV.

The best way to prevent transmission of HIV to an infant through breast milk is to not breastfeed. In the United States, where mothers have access to clean water and affordable replacement feeding (infant formula), CDC and the American Academy of Pediatricsexternal icon recommend that mothers living with HIV completely avoid breastfeeding their infants, regardless of ART and maternal viral load. Infant formula and pasteurized donor human milk are safe feeding alternatives to breastfeeding for mothers living with HIV.

In resource-limited settings, such as some parts of Africa, the World Health Organization (WHO) recommends that mothers living with HIV breastfeed exclusively for the first 6 months of life and continue breastfeeding for at least 12 months, with the addition of complementary foods. These mothers should be fully supported for ART adherence to reduce the risk of transmission through breastfeeding and for the mother’s own health.

What are the recommendations for counseling mothers living with HIV about feeding their infants?

Mothers who have questions about breastfeeding or who desire to breastfeed should receive patient-centered, evidence-based counseling on infant feeding options, allowing for shared decision-making. Healthcare providers can share information about the risks of breastfeeding regarding HIV transmission and advise against breastfeeding. If mothers choose to breastfeed, providers should emphasize the importance of adherence to ART and sustained viral suppression and address challenges to ART adherence during the postpartum period. Mothers living with HIV who choose to breastfeed should receive close follow-up and be supported in risk-reduction measures to minimize the risk of HIV transmission to their infants. Healthcare providers are encouraged to consult the National Perinatal HIV Hotline (1-888-448-8765) if they have questions regarding mothers living with HIV who desire to breastfeed.

Healthcare providers should be aware that some mothers with HIV may experience social or cultural pressure to breastfeed. These mothers may need ongoing feeding guidance and/or emotional support.

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