May 20, 2024 – People with HIV may consider breastfeeding their newborn babies because the benefits may outweigh the very small risk of transmitting the virus through breast milk, the nation’s largest group of pediatricians now says.
The option may be considered by mothers who are taking antiretroviral therapy (ART) that has effectively rendered the virus undetectable, according to the American Academy of Pediatrics. ART suppresses the virus from replicating in the body.
A small risk of transmission (below 1%) remains, and exclusive breastfeeding should continue for at least 6 months because switching between formula and breast milk may increase the risk of transmission. The only way to eliminate the risk of transmission is not to breastfeed.
“However, people with HIV may express a desire to breastfeed, and pediatricians should be prepared to offer a family-centered, nonjudgmental, harm-reduction approach to support people with HIV on ART ... who desire to breastfeed,” the new recommendation stated.
Breastfed babies experience protection from infectious diseases as well as from allergies, obesity, diabetes, and sudden infant death syndrome. And the breastfeeding parent experiences a reduction in the risk of breast and ovarian cancer, high blood pressure, and type 2 diabetes.
Almost 5,000 people with HIV give birth annually in the U.S. The virus can be transmitted during pregnancy, delivery, or breastfeeding.
The American Academy of Pediatrics (AAP) announced the change Monday in the new edition of its journal, Pediatrics. Last year, numerous other public health groups updated their recommendations, including the World Health Organization and the U.S. Department of Health and Human Services.
“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 pediatrician Lisa L. Abuogi, MD, lead author of the report, in a statement. “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.”
Its new recommendation comes amid “a growing number of reports of people with HIV desiring to breastfeed, with motivations including a desire to bond with their infant, an opportunity to provide optimal infant nutrition and health benefits, the ability to fulfill their role as a parent, and the need to meet cultural expectations,” the report stated. “Importantly, some people with HIV report concerns that within their communities, not breastfeeding will effectively disclose their HIV infection status to family and friends.”
Breastfeeding parents with undetectable HIV should be tested every 1 to 2 months, the AAP advised. Among the reasons for the new recommendation is that some people who wanted to breastfeed were not supported by their medical team and chose to breastfeed anyway without disclosing it, the authors wrote.
