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Breastfeeding With HIV: AAP Shifts Position

The American Academy of Pediatrics (AAP) has changed its approach to infant feeding among people with human immunodeficiency virus (HIV). It is the first change to its breastfeeding recommendation for parents with HIV since the start of the HIV epidemic in the 1980s.

AAP's position, which now aligns with recommendations by the Centers for Disease Control and Prevention, is outlined in an updated report published in the June 2024 Pediatrics.

The AAP clinical report, "Infant Feeding for Persons Living With and at Risk for HIV in the United States," is a critical evidence-based update that marks a reversal after decades of recommending against breastfeeding or providing breast milk to infants of people with HIV.

Nearly 5,000 people with HIV in the U.S. give birth every year. Without treatment, pregnant people with HIV can pass the virus to their infants during pregnancy, delivery or breastfeeding. Today, medications are available that, if taken every day, can keep people with HIV healthy and significantly reduce the risk of transmission.

Antiretroviral treatment, viral load & risk of HIV transmission through breastmilk

"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 Lisa L. Abuogi, MD, MSc, FAAP, lead author of the clinical report. The report was written by the AAP Committee on Pediatric and Adolescent HIV and Section on Breastfeeding.

"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," Dr. Abuogi said.

Considering the many benefits of breastfeeding

Research finds that the risk of HIV transmission via breastfeeding from a parent who is receiving antiretroviral treatment and is virally suppressed is estimated to be less than 1%. This small risk should be weighed against the numerous health, psychosocial, and financial benefits of breastfeeding.

The CDC, which began recommending against breastfeeding for people with HIV in 1985, has updated its position and now supports shared decision-making regarding infant feeding for people with HIV who wish to breastfeed. The AAP has strongly supported breastfeeding for decades, and now supports this infant feeding choice in people with HIV who are on successful treatment.

The AAP recommends that pediatric health care professionals:

  • Know the HIV status of the pregnant individual to provide appropriate infant feeding counseling and encourage perinatal HIV testing. Those who are known to be living with HIV or who are newly diagnosed should be linked to treatment.

  • Be prepared to support people with HIV who want to breastfeed if they meet all of the following criteria: They initiated antiretroviral treatment early in or prior to pregnancy; they maintain viral suppression; have continuous antiretroviral treatment access; and are committed to continuing treatment consistently through breastfeeding.

  • Counsel pregnant and postpartum people who are at increased risk of acquiring HIV, including people who inject drugs or who have sexual partners living with HIV who are not virally suppressed, regarding the potential risk of HIV transmission to an infant through human milk if HIV acquisition were to occur while breastfeeding and refer for pre-exposure prophylaxis of HIV (PrEP) medications.

"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," Dr. Abuogi said.

"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," Dr. Abuogi said.

AAP policy statements and technical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.

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American Academy of Pediatrics (Copyright @ 2024)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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