Risk of transmission through breast milk

For mothers on ART with a sustained undetectable HIV viral load during and after pregnancy, the risk of transmission through breastfeeding is less than 1%, but not zero.

Recommendations

Mothers with HIV who have questions about breastfeeding or who want to breastfeed need patient-centered, evidence-based counseling on infant feeding options to allow for shared decision-making. Counseling should allow mothers and health care providers to work together to make infant feeding decisions. Begin counseling before becoming pregnant or as early as possible during pregnancy. Counseling on infant feeding should continue throughout the pregnancy and again after delivery.

Reducing transmission through breast milk

The risk of transmitting HIV through breast milk can be reduced by:

• Replacing breastfeeding with properly prepared formula or pasteurized donor human milk from a milk bank. This eliminates the risk of HIV transmission to the infant after birth.
• Achieving and maintaining viral suppression through ART during pregnancy, delivery, and after birth. This decreases risk of transmission through breastfeeding to less than 1%, but not zero.

If mothers choose to breastfeed, providers should emphasize the importance taking ART as directed and sustaining an undetectable HIV viral load. Providers should also address challenges to taking ART as directed after birth.

Follow-up care

Mothers with HIV who choose to breastfeed should receive close follow-up care and be supported in minimizing the risk of HIV transmission to their infants. Health care providers can call the National Perinatal HIV/AIDS Hotline (1-888-448-8765) with questions about mothers with HIV who want to breastfeed.

For comprehensive information, refer to Infant Feeding for Individuals With HIV in the United States. These recommendations are included within the Department of Health and Human Services Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States.