Moms living with HIV can safely breastfeed their babies if they’re on HIV meds and maintain an undetectable viral load, according to new recommendations from the American Academy of Pediatrics (AAP) published in the journal Pediatrics.

“The risk of HIV transmission via breastfeeding from a parent with HIV who is receiving antiretroviral treatment (ART) and is virally suppressed is estimated to be less than 1%,” according to the article. (Note: The same guidelines apply to chest feeding for trans men.)

 

The pediatrics group had previously advised that women with HIV not breastfeed their infants regardless of their viral load and treatment regimen due to the risk of mother-to-child transmission.

 

Untreated HIV can be transmitted through breast milk as well as blood, semen, pre-cum and rectal and vaginal fluids.

 

Thanks to effective treatment, many people with HIV are living healthy lives and planning families. In fact, about 5,000 people with HIV give birth each year in the United States.

 

Antiretroviral treatment is recommended for all people with HIV to reduce morbidity and mortality and to prevent the transmission of HIV to others. A person who adheres to meds consistently and maintains an undetectable viral load does not transmit HIV to another person via sex. This fact is referred to as Undetectable Equals Untransmittable (U=U).

 

Things have changed in the era of U=U. The viral load threshold for reducing transmission via breastfeeding is unknown, but only a couple of cases of transmission from mothers with a viral load below 50 have been reported.

 

Moving forward, AAP recommends that pediatricians offer support and counseling for those who opt for breastfeeding and are on ART as prescribed and achieving viral suppression, according to the AAP report.

 

“The AAP recommends that for people with HIV in the United States, replacement feeding (with formula or certified, banked donor human milk) is the only option that is 100% certain to prevent postnatal transmission of HIV,” the report states. “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.”