• Posted May 20, 2024

In a Shift, Pediatricians' Group Says Breastfeeding Safe When HIV-Positive Mom Is Properly Treated

The nation’s top pediatrics group has reversed its decades-old position on HIV-positive mothers breastfeeding their infants.

The American Academy of Pediatrics now says it’s generally safe for moms with HIV to breastfeed or provide breast milk to babies if their infection is properly controlled.

The risk of HIV transmission through breastfeeding from a mother who is virally suppressed is less than 1%, according to an AAP evidence review published May 20 in the AAP journal Pediatrics.

That small risk should be weighed against the health and financial benefits of breastfeeding, the AAP says.

“Research now shows that the risk of HIV transmission through breastfeeding is quite low when the lactating parent is on anti-retroviral treatment and has no detectable viral load,” said Dr. Lisa Abuogi, lead author of the AAP review.

“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 Abuogi, who is medical director for the Children's Hospital Colorado Immunodeficiency HIV Prevention Program.

Nearly 5,000 people with HIV in the United States give birth every year, the AAP says.

Without treatment, women with HIV can pass the virus to their infants during pregnancy, delivery or breastfeeding.

However, daily medications can keep people with HIV healthy and reduce their viral load below detectable levels, the AAP noted.

The AAP says it is following the lead of the U.S. Centers for Disease Control and Prevention, which starting in 1985 had recommended against breastfeeding for people with HIV. The CDC now supports breastfeeding for HIV-positive mothers after discussing the option with a doctor.

The AAP recommends that pediatricians:

• Know the HIV status of pregnant women, to provide appropriate counseling and prescribe antiretroviral treatment

• Be prepared to support HIV-positive women who want to breastfeed if they started antiretroviral treatment early in or prior to pregnancy and are committed to maintaining  viral suppression through breastfeeding

• Counsel pregnant women and new mothers at increased risk of HIV infection regarding the risk of transmitting the virus through human milk, if infection occurred while breastfeeding

 “Healthcare professionals, researchers and people with HIV have made amazing strides over the past few decades towards eliminating perinatal transmission of HIV in the United States,” Abuogi said in an AAP news release. "We encourage families to share information with their pediatricians about HIV and discuss what will work best for them when it comes to feeding their baby.”

More information

The U.S. Centers for Disease Control and Prevention has more about HIV and breastfeeding.

SOURCE: American Academy of Pediatrics, news release, May 20, 2024