Human Immunodeficiency Virus (HIV)

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.

What is the risk of HIV transmission through breast milk?

For mothers on antiretroviral therapy (ART) with a sustained undetectable HIV viral load during pregnancy, the risk of transmission through breastfeeding is less than 1%, but not zero.

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

Mothers who have questions about breastfeeding or who want to breastfeed should receive patient-centered, evidence-based counseling on infant feeding options, allowing for shared decision-making. Counseling should begin before conception, or as early as possible in pregnancy and should be reviewed throughout the pregnancy and again after delivery. During counseling, healthcare providers can share information about ways to reduce the risk of HIV transmission through breast milk:

• Replacement feeding with properly prepared formula or pasteurized donor human milk from a milk bank eliminates the risk of postnatal HIV transmission to the infant.
• Achieving and maintaining viral suppression through ART during pregnancy, delivery, and postpartum decreases risk of transmission through breastfeeding to less than 1%, but not zero.

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 with HIV who choose to breastfeed should receive close follow-up and be supported in minimizing the risk of HIV transmission to their infants. Healthcare providers are encouraged to consult the National Perinatal HIV/AIDS Hotline (1-888-448-8765) if they have questions regarding mothers with HIV who want to breastfeed.

For comprehensive information, refer to Infant Feeding for Individuals with HIV in the United States. These recommendations are included within the Department of Health and Human Services (HHS) Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States.