Breastfeeding with HIV: Safe Practices for Moms on Effective Treatment

Background and New Guidelines

Recent guidelines from the American Academy of Pediatrics (AAP) indicate that some mothers with HIV can safely breastfeed their infants if they are on antiretroviral therapy (ART) and have undetectable viral loads. This marks a significant shift from previous advice that discouraged breastfeeding to prevent HIV transmission.

These changes are supported by recent evidence demonstrating minimal risk of HIV transmission during breastfeeding when the mother is adhering to ART and maintains an undetectable viral load.

Criteria for Safe Breastfeeding

For mothers with HIV who wish to breastfeed, certain criteria must be met to ensure safety. These include initiating ART early in or before pregnancy, maintaining consistent viral suppression with viral loads under 50 copies/mL, continuous access to and adherence to ART, and providing infants with antiretroviral prophylaxis.

Under these conditions, the risk of transmitting HIV through breast milk is significantly diminished—estimated to be less than 1%.

Why the Change?

Accumulating evidence over the years has highlighted that the risk of HIV transmission from virally suppressed mothers to their breastfeeding infants is very low, prompting health officials to reconsider previous recommendations.

Although the risk is not entirely zero, this clinical report aligns with findings from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) that the benefits of breastfeeding can outweigh the very small risk of transmission.

Global and Local Perspectives

The global landscape on breastfeeding recommendations for mothers with HIV has varied. Since 2016, the WHO has advised that breastfeeding with ART and infant prophylaxis is safe, particularly in areas where clean water and nutrition alternatives are scarce.

This more unified approach helps avoid conflicting advice for HIV-positive mothers who move between different countries with varying recommendations.

Implementing the Guidelines

Despite the new AAP guidelines, implementation in clinical practice may take time. Clinicians who were trained under previous advisories might need additional education to adapt to these changes.

The AAP aims to facilitate this transition by offering educational resources and webinars to update healthcare providers on the new safety guidelines for breastfeeding among HIV-positive mothers.

Clinical Recommendations

Further recommendations from the AAP report include counseling for parents who wish to breastfeed, regular HIV screening for breastfeeding infants, and close monitoring for any potential antiretroviral drug side effects in infants.

These measures ensure that both mother and baby receive the best possible care during the breastfeeding period.