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It’s no surprise that myHIVteam members have questions about whether they can breastfeed while HIV-positive. “I’m hoping that as good as I’m doing with maintaining undetectable viral loads and a high CD4 count, I would be able to breastfeed my newborn,” one member wrote. “Are there any options for people who are HIV-positive and undetectable? Can you breastfeed with HIV?”
HIV damages the immune system and can lead to AIDS, a serious condition that may develop in people who have the virus. Fortunately, with proper treatment and care, people living with HIV can lead healthy and fulfilling lives. For people living with HIV who are considering pregnancy, many options are available to help them have healthy pregnancies and children. However, when it comes to breastfeeding, it’s important to be aware of the potential risks and make an informed decision.
Deciding whether to breastfeed as a parent living with HIV can be complex and challenging. You’ll need to carefully consider the risks and benefits. The following are some important factors to consider.
Breastfeeding provides many health benefits for both you and your baby. In fact, the World Health Organization generally recommends that parents without HIV exclusively breastfeed their babies up until the age of 6 months. Because you pass antibodies to your baby through breast milk, breastfeeding can help your baby fight off some infections.
Additionally, breastfed infants have a lower risk of sudden infant death syndrome (SIDS), asthma, obesity, and type 1 diabetes. For the parent, breastfeeding decreases the chance of developing type 2 diabetes, high blood pressure, and some types of cancer.
Finally, breastfeeding can also help strengthen the bond between a parent and their baby. Skin-to-skin contact and the act of nursing can provide comfort and security for the baby, reduce stress, and promote relaxation. Your healthcare professionals can help you weigh the risks and benefits to decide whether exclusive breastfeeding is an option for you and your baby.
Many people wonder: Can HIV be transmitted through breast milk? Understanding the risks involved is crucial for making informed decisions. Breastfeeding is a potential route of HIV transmission. This means a parent who is HIV-positive is at risk of transmitting the virus to their infant. The risk of transmission depends on various factors, such as the duration of breastfeeding and the levels of HIV in the parent’s body.
HIV cannot be transmitted through casual contact, such as hugging, kissing, or sharing utensils. The virus can only be transmitted through bodily fluids, including blood, semen, vaginal fluids, and breast milk.
HIV can spread from a parent to a baby during pregnancy, delivery, or breastfeeding because the virus is in bodily fluids like blood and breast milk. However, taking HIV medicine can reduce the chance of giving HIV to the baby to below 1 percent by keeping the virus level very low in the parent’s body.
Babies who are born to HIV-positive mothers and are also breastfed are at risk of contracting HIV through breast milk. To reduce the risk of transmission, health researchers recommend that these babies receive antiretroviral treatment (ART) as a preventive measure. Your doctor may call this antiretroviral prophylaxis.
In addition to receiving ART, babies breastfed by a parent who’s HIV-positive should be closely monitored by healthcare professionals to ensure they’re healthy and developing normally. Regular checkups and HIV testing can help identify any potential problems early and ensure that the baby receives prompt treatment if needed.
Managing ART for a baby can be challenging, but it’s a crucial step in protecting their health and reducing the risk of HIV transmission.
There are several feeding options available for parents who are HIV-positive and choose not to breastfeed or are advised against it. These choices include formula feeding, donor breast milk, combination feeding, and flash heating.
Formula feeding is a safe and effective option for feeding your baby if you decide not to breastfeed. With formula feeding, the risk of transmitting HIV to your baby through food is eliminated. Commercial infant formula is nutritionally complete and can provide all of the nutrients your baby needs to grow and develop.
It is important to prepare and store formula correctly to reduce the risk of contamination with harmful bacteria. Your healthcare provider can provide guidance on how to safely and effectively formula feed your baby.
Using donor breast milk may be another option if you choose not to breastfeed. Donor breast milk refers to milk donated by other lactating parents, and it’s screened for HIV and other infections. It is also often pasteurized (sterilized like store-bought cow’s milk) to destroy any potential infectious diseases like HIV or hepatitis. However, donor breast milk can be expensive, and the supply for milk banks is not guaranteed.
Combination feeding, or mixed feeding, involves both breastfeeding and formula feeding. This may be an option for some parents who have a positive HIV status, undetectable viral loads through pregnancy, and want to breastfeed but cannot exclusively breastfeed because of a lack of supply. Viral load is the amount of HIV in your blood.
Combination feeding may help reduce the risk of transmitting HIV through breast milk while still providing some of the health benefits of breastfeeding. Mixed feeding might be necessary if your milk supply runs low or if your baby is not gaining enough weight.
However, it is important to discuss the risks and benefits of combination feeding with your healthcare provider, as this may not be appropriate in all situations.
Studies show that heating breast milk quickly after pumping can eliminate most HIV. This is called flash heating. Flash heating may be useful if you do not have any other options to feed your baby. If your nipples are bleeding or if you develop mastitis (an infection in your breast), ask your doctor if flash heating your breast milk is a safe option.
In the United States, doctors do not usually recommend flash heating because there are safer options, like baby formula or milk donated by other parents that has been pasteurized and tested. Flash heating might be used in places where these options are not available, but it’s not the first choice in places where safe formula or donor milk is available.
The decision to breastfeed should be made in consultation with a healthcare provider, taking into account individual circumstances and preferences.
Factors to consider include:
You may also weigh other personal considerations when deciding whether or not to breastfeed. For example, some parents face a cultural expectation to breastfeed, and they worry that deciding not to will let others know that they are HIV-positive. In other cases, formula may be too expensive or not available.
Before you decide whether to breastfeed, you should have your viral load tested. If your viral load is high, it’s important to understand whether HIV can be transmitted through breast milk. A high viral load also increases the risk that your baby will be infected with HIV through breast milk. If your HIV levels were not low during pregnancy and birth, breastfeeding may not be safe. But if your levels stayed very low, you and your doctor can talk about whether it’s OK to breastfeed.
If your viral load is undetectable — meaning your blood contains very low levels of HIV — the risk of transmitting HIV to your baby is greatly reduced. It’s important to receive HIV treatment, such as ART, during and after pregnancy to reduce the risk of parent-to-child transmission of HIV.
Some parents might be worried about exposing their baby to ART medicines through their breast milk. Studies show that the levels of ART medication found in breast milk are lower than the levels in their blood, and the risk of side effects for babies on ART or breastfed by a parent on ART is low.
If you develop detectable viral loads, you should stop breastfeeding immediately.
If you’re on ART and had an undetectable viral load during pregnancy, the risk of giving your baby HIV through breastfeeding is very low. According to the World Health Organization, “ART is very effective at preventing HIV transmission through breastfeeding,” as long as the breastfeeding parent adheres to the therapy. That said, the risk is still higher than zero, and because HIV is a lifelong disease, some people may find this risk to be too high. As more people with HIV breastfeed while on ART, researchers are gathering more data to determine if it is safe.
Your healthcare providers, including your HIV care team, OB-GYN, and lactation support provider, are your best resources when it comes to managing your HIV during and after your pregnancy. They can provide guidance on reducing your viral load, choosing the best feeding option for your baby, and preventing the transmission of HIV to your baby. With proper care and treatment, people living with HIV can have healthy pregnancies and raise healthy children.
It’s important to be honest with your healthcare providers about your HIV status and your plans for feeding your infant. Your doctor might not be aware of the latest recommendations for breastfeeding while HIV-positive. If this is the case, you can refer them to the national Perinatal HIV/AIDS hotline (888-448-8765).
On myHIVteam, the social network for people with HIV and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with HIV.
Are you living with HIV and pregnant, or have you recently had a child? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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