Human immunodeficiency virus (HIV)

Can I breastfeed if I am HIV-positive?

HIV, the virus that sometimes leads to AIDS, can be controlled with antiviral medication but cannot yet be cured. If a mother has HIV and is not being treated, the virus will be transmitted to her baby by breastfeeding in 20% to 45% of cases, the World Health Organization says. When the mother is monitored and treated, the risk is much lower. It also seems to be lower when the baby is exclusively rather than partially breastfed. In low-income countries, mothers with HIV who are monitored and are taking antiviral medication are encouraged to breastfeed, because the risks of infection and disease from HIV are lower than the risks of infant formula use. In high-income countries, organizations currently recommend that mothers with HIV not breastfeed.

A) Describing infection with human immunodeficiency virus

The human immunodeficiency virus (HIV) can lead to acquired immune deficiency syndrome (AIDS) and make a person unable to fight infection or kill cancerous cells. HIV infection can be controlled with antiviral medication but cannot yet be cured. 

If you are HIV positive, please discuss breastfeeding with your health-care providers.

B) Breastfeeding with HIV

Mothers with HIV can transmit the infection to their baby through breastfeeding. The risk is much lower when the mother is taking antiviral drugs. Treating babies with antiviral drugs may further decrease the risk (Flynn et al. 2018).

When babies are given both breast milk and infant formula (partial breastfeeding), HIV transmission to the baby is more likely than when they are exclusively breastfed (Mwau 2017; Wise 2001). 

Guidelines on whether mothers who are HIV-positive should breastfeed are based on the mother’s situation and on where she lives (Givens 2021; WHO 2017).

In low-income countries where breastfeeding is the norm or where infant formula may be unavailable, unsafe, or unaffordable, mothers who are monitored and are taking antiviral medication are encouraged to breastfeed. The risks of infection and disease from HIV are lower than the risks of illness, malnutrition and death caused by infant formula use. 

Currently, organizations in high-income countries recommend that mothers not breastfeed if they are HIV-positive however (Anderson 2020; CPA 2013; Keshmiri 2018; Taylor 2011).

References

Anderson PO. Breastfeeding by Women with HIV Infection. Breastfeed Med. 2020 Jun 23

Committee on Pediatric Aids (CPA). Infant feeding and transmission of human immunodeficiency virus in the United States. Pediatrics. 2013 Feb;131(2):391-6
 
Flynn PM, Taha TE, Cababasay M, et al. Prevention of HIV-1 Transmission Through Breastfeeding: Efficacy and Safety of Maternal Antiretroviral Therapy Versus Infant Nevirapine Prophylaxis for Duration of Breastfeeding in HIV-1-Infected Women With High CD4 Cell Count (IMPAACT PROMISE): A Randomized, Open-Label, Clinical Trial. J Acquir Immune Defic Syndr. 2018 Apr 1;77(4):383-392

Givens M, Levison J, Rahangdale L. Considerations and Recommendations for Pregnancy and Postpartum Care for People Living With Human Immunodeficiency Virus. Obstet Gynecol. 2021 Jul 1;138(1):119-130 

Keshmiri R, Coyte PC, Laporte A, et al. Cost-effectiveness analysis of infant feeding modalities for virally suppressed mothers in Canada living with HIV. Medicine (Baltimore). 2019 Jun;98(23):e15841
 
Mwau M, Bwana P, Kithinji L, et al. Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years. PLoS One. 2017 Aug 29;12(8):e0183860
 
Taylor GP, Anderson J, Clayden P, et al. British HIV Association and Children's HIV Association position statement on infant feeding in the UK 2011. HIV Med. 2011 Aug;12(7):389-93
 
Wise J. Breast feeding safer than mixed feeding for babies of HIV mothers. BMJ. 2001 Mar 3;322(7285):511.
 
World Health Organization (WHO). Infant feeding for the prevention of mother-to-child transmission of HIV. Geneva: World Health Organization; 2017 Jun 15