Infant feeding for the prevention of mother-to-child transmission of HIV
Mother-to-child transmission of HIV is the primary mode of HIV infection in infants. Transmission can occur during pregnancy, birth, or through breastfeeding. Decisions on whether or not HIV-infected mothers should breastfeed their infants is generally based on comparing the risk of infants acquiring HIV through breastfeeding, with the increased risk of death from malnutrition, diarrhoea and pneumonia if the infants are not exclusively breastfed.
Accumulating evidence has shown that giving antiretroviral medicines to the mother or the infant can significantly reduce the risk of HIV transmission through breastfeeding. National health authorities can refer to this evidence when formulating a strategy on infant feeding.
Mothers known to be HIV-infected should be provided with lifelong antiretroviral therapy or antiretroviral prophylaxis interventions to reduce HIV transmission through breastfeeding.
National or sub-national health authorities should decide whether health services will principally counsel mothers known to be HIV-infected to either breastfeed and take antiretrovirals, or, avoid all breastfeeding.
In settings where national health authorities are recommending breastfeeding for HIV-infected mothers:
Mothers known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status) should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary foods thereafter, and continue breast feeding.
Mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or longer (similar to the general population) while being fully supported for ART adherence (see the WHO Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection for interventions to optimize adherence).
In settings where health services provide and support lifelong ART, including adherence counselling, and promote and support breastfeeding among women living with HIV, the duration of breastfeeding should not be restricted.
Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided.
National and local health authorities should actively coordinate and implement services in health facilities and activities in workplaces, communities and homes to protect, promote and support breastfeeding among women living with HIV.
This is a summary of WHO recommendations. The full set of recommendations can be found in the guidelines and guidance documents, under ‘WHO documents’ below.
Updates on HIV and infant feeding
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection
Guidelines on HIV and infant feeding 2010: principles and recommendations for infant feeding in the context of HIV and a summary of evidence
Other guidance documents
Systematic reviews used to develop the guidelines
HIV-free survival at 12 – 24 months in breastfed infants of HIV-infected women on ART: a systematic review
Postnatal HIV Transmission rates at age six and 12 months in infants of HIV-infected women on ART initiating breastfeeding: a systematic review of the literature
An analysis of optimal breastfeeding durations for HIV-Exposed Infants: Assessing the impact of naternal ART use, infant mortality, and replacement feeding risk
A systematic review of HIV-free survival by feeding practices from birth to 18 months: Annex 2
Individual evidence summaries of all studies included in the systematic review of HIV-free survival by infant feeding practices from birth to 18 – 24 months: Annex 5