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 for the first 12 months of life.
Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided.
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.
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
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