Breastfeeding with HIV positivity - is it possible?

The WHO advises HIV-positive mothers against breastfeeding to avoid transmission. But more countries are now providing their own recommendations.

You should know:

Mothers often wish they could breastfeed

The WHO recommendation that HIV-positive mothers should not breastfeed often leads those affected to breastfeed in secret. The WHO guideline is based on the risk of infecting the infant with HIV through breast milk. However, recent studies suggest that the transmission rate is extremely low when the mother has reached undetectability. 

A new initiative from Australia

In Australia, new recommendations have been developed with the help of patient associations. This shows that breastfeeding can be a viable option if the mother has reliably taken her antiretroviral therapy (ART), the virus is no longer detectable in the blood and precautions have been taken to avoid infecting the child.

In Australia, a study was conducted in which HIV-positive mothers on antiretroviral therapy, in whom the virus was no longer detectable in the blood, breastfed their children. 0.3% of the breastfed children became infected with HIV. The researchers emphasise that not all of the participating mothers also reliably took their medication.

Conclusion for medical practice

Under certain circumstances, breastfeeding can also be an option for HIV-positive mothers. Especially when the virus is no longer detectable through ART. However, transmission to the child cannot be completely ruled out. The data situation provides food for thought, which could possibly lead to a change in the WHO recommendations in the future. Currently, bottle feeding is considered the safest option for HIV-positive mothers of infants.

For more papers, visit our AIDS 2022 congress page.

Session: Breast is best? Making infant feeding options available for all women living with HIV. Heather ELLIS, Positive Women Victoria, Australia, Changing the guidelines, AIDS 2022, 31.7.2022.