Moms with HIV can breastfeed if taking treatment and virus is undetectable, pediatricians' group says

Each time a mother looks at photos of herself breastfeeding her baby for the first time, she swells with emotion. For the first time, the American Academy of Pediatrics has changed its position to say people with HIV can breastfeed their infants with ‘very low’ risk if they follow certain guidelines. Avoiding breastfeeding is the only option with zero risk for HIV transmission, but going forward, pediatricians should offer support and counseling for women who wish to breastfeed and are receiving antiretroviral treatment. Previously, the academy recommended that mothers with HIV in the United States not breastfeed their infants, regardless of their viral load and antiretroviral therapy use. Recommendations against breastfeeding for people with HIV date to about 1985. The new report says replacement feeding is the only option that is 100% certain to prevent postnatal transmission of HIV. However, pediatric health care professionals should be prepared to provide infant feeding counseling and a family-centered, culturally sensitive, harm reduction approach for people with HIV on ART with sustained viral suppression who desire to breastfeed. HIV is a virus that attacks the body’s immune system. Research has shown that the use of antiretroviral drugs can significantly reduce the risk of HIV transmission through breastfeeding. In the absence of the mother taking ART or the infant taking preventive antiretrovirals, the risk of HIV transmission through breast milk appears to be highest in the baby’s first four to six weeks of life. But the risk is ’estimated to be less than 1%’ if the mother is taking antiretroviral medications and the virus is suppressed in her body. The new AAP position now aligns with similar updates to its recommendations around infant-feeding from the US Department of Health and Human Services. The AAP recommendations signal that there is now a consensus among leading medical groups that mothers living with HIV can be supported and counseled in safely breastfeeding their babies.