Is it breast feeding safe if you are HIV positive? In a move that will reassure HIV posititve parents who may be considering breastfeeding, the American Academy of Pediatrics (AAP) provides new guidance for parents and their doctors.
The AAP has changed its stance on breastfeeding for people carrying Human Immunodeficiency Virus (HIV). Previously, they recommended against it, due to the risk of transmitting the virus to the infant. However, new research shows that this risk is very low when the parent is taking antiretroviral medication and has no detectable viral load.1,2
A changing landscape
The AAP now supports shared decision-making regarding infant feeding for people with HIV who wish to breastfeed. This marks a significant shift from the long-standing recommendation against breastfeeding by mothers with HIV, first issued in 1985.3
“While avoiding breastfeeding is the only option to guarantee that the virus is not transmitted, pediatricians should be ready to offer family-centered and nonjudgmental support for people who desire to breastfeed,” said Lisa L. Abuogi, MD, MSc, FAAP, lead author of the clinical report, in a news release.1
This change in policy was published in June 2024 Pediatrics.2 It recognizes the importance of breastfeeding for both infants and parents and ensures that people with HIV have the same access to information and support as those without the virus.
Is Breast Always Best?
About 30% of mother-to-child HIV transmission happens through breastfeeding. This mainly occurs when the mother is not taking antiretroviral (ARV) drugs or is not virally suppressed (meaning the virus is still detectable in their blood).
Without ARVs, the transmission risk is highest in the first 4-6 weeks of the baby’s life (5-6% chance). The risk decreases over time but remains present throughout breastfeeding (around 0.9% each month).
Studies have demonstrated that the risk of HIV transmission through breast milk drops to less than 5% when ARVs are used, and to less than 1% when the mother is receiving ARV therapy and has an undetectable viral load. Mothers should weigh this minimal risk, according to the AAP, against the numerous health, psychosocial, and financial benefits linked to breastfeeding.
AAP Recommendations for HIV and Breast Feeding
To ensure the safety of both mother and infant, the AAP recommends that pediatricians:1
- Confirm the HIV status of pregnant individuals: This allows for appropriate infant feeding counseling and encourages perinatal HIV testing.
- Provide support for breastfeeding mothers with HIV: This support should be offered when mothers meet specific criteria, including early initiation of antiretroviral treatment, maintained viral suppression, consistent access to treatment, and a commitment to continued treatment throughout the breastfeeding period.
- Offer counseling and PrEP referrals: Pregnant and postpartum individuals at an increased risk of acquiring HIV, such as those who inject drugs or have partners with unsuppressed HIV, should be counseled about the potential risk of transmission through breast milk and referred for pre-exposure prophylaxis (PrEP) medications.
Every individual’s situation is unique. If you have any concerns about HIV and infant feeding, including breastfeeding, talk with your doctor. They can provide personalized advice and support tailored to your specific needs and circumstances.
References
- American Academy of Pediatrics shifts position on breastfeeding for people with human immunodeficiency virus (no date) Home. Available at: https://www.aap.org/en/news-room/news-releases/aap/2024/american-academy-of-pediatrics-shifts-position-on-breastfeeding-for-people-with-human-immunodeficiency-virus/ (Accessed: 16 November 2024).
- Abuogi L, Noble L, Smith C; COMMITTEE ON PEDIATRIC AND ADOLESCENT HIV ; SECTION ON BREASTFEEDING . Infant Feeding for Persons Living With and at Risk for HIV in the United States: Clinical Report. Pediatrics. 2024;153(6):e2024066843. doi:10.1542/peds.2024-066843
- Goga A, Coutsoudis A. HIV and Infant Feeding. In: Mehta S, Finkelstein JL, editors. Nutrition and HIV: Epidemiological Evidence to Public Health. New York (NY): CRC Press; 2018 May 15. Chapter 7. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572226/#doi: 10.1201/9781351058193-7
