“That’s how important it was to me to be able to breastfeed,” LaTonya explained about the photos. “I wanted to make sure we had that memory forever.”
For the first time, the American Academy of Pediatrics (AAP) has updated its stance, stating that individuals with HIV can breastfeed their infants with “very low” risk if they adhere to specific guidelines and receive support from their healthcare team.
Although avoiding breastfeeding is the only way to ensure zero risk of HIV transmission, the AAP now recommends that pediatricians provide support and counseling for mothers who wish to breastfeed, are receiving antiretroviral treatment (ART), and maintain an undetectable viral load. This new clinical report was published in the journal Pediatrics.
Previously, the AAP advised against breastfeeding for mothers with HIV in the United States, regardless of their viral load and ART use. Recommendations against breastfeeding for people with HIV date back to about 1985 when the US Centers for Disease Control and Prevention first recommended that women with HIV avoid breastfeeding.
“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.”
HIV is a virus that attacks the immune system and, if untreated, can lead to acquired immunodeficiency syndrome (AIDS).
LaTonya, who has been living with HIV for about 20 years, knew she wanted to breastfeed her son because of the numerous health benefits breastfeeding offers, such as a lower risk of asthma, obesity, type 1 diabetes, and sudden infant death syndrome (SIDS).
“Being a mom is absolutely amazing. I wouldn’t trade it for the world,” LaTonya said, adding that every parent wants to give their child “the best shot” at becoming the best person they can be. “I feel like breastfeeding was a step towards me being able to provide that for him.”
After discussing her decision with her doctors, they developed a plan for her to breastfeed since her viral load is undetectable and she is taking antiretroviral medications. They emphasized the importance of “constant monitoring of viral loads” and complete adherence to medication.
“I think it’s essential for people to understand the science behind it,” LaTonya said. “If you’re undetectable, you cannot transmit HIV to your partner. It’s crucial for people to understand that, and if you adhere to your medication, it’s not going to transfer through breast milk to your child. So, why deprive your child of that benefit?”
While HIV can be transmitted to infants through breastfeeding, research indicates that antiretroviral drugs significantly reduce this risk, and these medications are safe during breastfeeding. Without ART for the mother or preventive antiretrovirals for the infant, the highest risk of HIV transmission through breast milk occurs in the first four to six weeks of life, ranging between 5% and 6%. However, the risk is “estimated to be less than 1%” if the mother is on ART and maintains an undetectable viral load.
“What’s new is that the AAP for the first time is explicitly saying that pregnant people with HIV who are on treatment and undetectable can be supported to breastfeed,” said Dr. Lisa Abuogi, lead author of the report and a pediatrician in Colorado who works with people with HIV during their pregnancies. “This has been a long evolution, and people living with HIV have been part of advocating for this change.”
It’s estimated that about 5,000 people with HIV give birth in the United States each year. “So having the opportunity to offer women the choice, as all women have, and to support their decision is really empowering,” Abuogi said. “People living with HIV should have all the same infant-feeding options as anyone else, and we’re working to make that a safe decision for women.”
Last year, an advisory panel to the US Department of Health and Human Services (HHS) made similar updates to its infant-feeding recommendations, stating that “individuals with HIV who are on ART with a sustained undetectable viral load and who choose to breastfeed should be supported in this decision.” The new AAP position now aligns with these updated HHS guidelines.
“This is something that’s been under discussion for a few years now,” said Dr. Rana Chakraborty, a pediatric infectious disease specialist at the Mayo Clinic and a member of the HHS Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. “Investigators, including many from the US working in resource-limited settings, have shown that breastfeeding can be safe if the mother is on ART and maintains undetectable viral loads. In the US, this is also feasible, but it requires a multidisciplinary team to ensure safety for both mom and baby.”
