By: Lawrence Noble, MD, FAAP
For decades, the American Academy of Pediatrics (AAP) advised people with human immunodeficiency virus (HIV) against breastfeeding to avoid passing the virus to their infant. However, in light of how current HIV treatments can reduce the risk of HIV transmission through human milk, we have
changed our policy.
Here's what parents need to know about the policy change, and what to consider if you have HIV and would like to breastfeed your baby.
Why did AAP change its position on breastfeeding with HIV?
The reason for the change is that research now shows that the risk of HIV transmission through breastfeeding is very low when the nursing parent is on appropriate treatment, and when blood tests show that there is no detectable HIV.
While avoiding breastfeeding is the only option to guarantee that the virus is not transmitted, a parent with HIV who want to breastfeed or feed their pumped milk to their infant should now speak with their health care professionals to learn the safest way to do so.
What is the new policy?
The AAP breastfeeding recommendations are updated in our clinical report, "Infant Feeding for Persons Living With and at Risk for HIV in the United States."
In the report, we recognize that without treatment, pregnant people with HIV can pass the virus to their infants during pregnancy, delivery or breastfeeding. However, today, medications are available that, if taken every day, can keep people with HIV healthy—and significantly reduce the risk of transmitting the virus to their infants. The Centers for Disease Control and Prevention (CDC) has also
updated its policy.
How much can antiretroviral treatment reduce the risk of HIV transmission through breast milk?
Recent research finds that the risk of HIV transmission from breastfeeding—if the parent is receiving
antiretroviral treatment and tests show
viral suppression—is less than 1%. The lactating parent should weigh this small risk against the numerous health, psychosocial and financial
benefits of breastfeeding.
What should a pregnant person with HIV know before deciding whether to breastfeed?
The AAP recommends that parents living with HIV who want to breastfeed:
Start antiretroviral treatment early in or before pregnancy.
Maintain viral suppression.
Make sure they can get treatment while breastfeeding.
Stay committed to continuing treatment while they breastfeed.
We also recommend that parents living with HIV talk with their health care team about the risks and benefits of breastfeeding. This will help them decide what will work best for them when feeding their baby.
The AAP has strongly supported breastfeeding for decades and now support parental infant feeding choices in people with HIV who are on successful treatment. All healthcare professionals should support the family's decision to breastfeed or not breastfeed.
More information
Note: The term "breastfeeding" is used here. Some people may prefer other terminology, including "chestfeeding." Patients are encouraged to let their healthcare providers know their preferred language regarding infant feeding. About Dr. Noble
Lawrence Noble, MD, FAAP, is a neonatologist based in New York City. He is a member of the AAP Section on Breastfeeding leadership team and has authored numerous AAP policies and publications on breastfeeding.
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Lisa Abuogi, MD, MS, FAAP and Christiana Smith, MD, FAAP, also contributed to this article.