When considering how to feed your baby, mothers with HIV status may receive conflicting information and advice about the safety of breastfeeding. For many years, mothers living with the human immunodeficiency virus (HIV) in developing nations were encouraged to breastfeed, despite the risk of viral transmission through breast milk. This was mainly due to the lack of available resources in developing nations to purchase and prepare infant formula safely. In these areas of the world, the risk of not breastfeeding was more life-threatening than the long-term concerns about HIV transmission. Since mothers in the United States have access to clean water and resources to purchase and prepare infant formula—until recently—this was considered a safer alternative for mothers living with HIV, and breastfeeding was actively discouraged. 

Shifts in Current Knowledge

Today, the landscape has changed significantly due to advances in HIV treatment, especially the widespread use of antiretroviral treatment (ART). With consistent use of ART, many mothers now reach and maintain an undetectable viral load—often referred to as being virally suppressed. Emerging evidence shows that when a mother is on ART, has an undetectable viral load, and remains closely monitored, the risk of HIV transmission through breastfeeding is extremely low. These findings reflect the most recent guidelines and help clarify what we now understand about safety and health outcomes for both mother and baby.

In 2023, the U.S. Department of Health and Human Services released updated recommendations acknowledging that mothers who are on effective treatment for HIV and have sustained viral suppression may choose to breastfeed. These guidelines emphasize shared decision-making and individualized care.

What are the New Guidelines for HIV and Breastfeeding?

  • Mothers should be supported in their decision to breastfeed if they are taking ART, have had viral suppression for at least the last 3 months of pregnancy, and continue to have an undetectable viral load while breastfeeding.

  • Viral testing should occur every 3 months to ensure continued safety.

  • The risk of transmission through breastfeeding is very low (less than 1%), though not zero, for mothers using antiretroviral drugs with a consistently undetectable viral load.

  • If breastfeeding is chosen, exclusive breastfeeding for the first 6 months is recommended, but even partial breastfeeding while the mother is on ART significantly reduces the risk of postnatal HIV transmission and offers numerous health and immunological benefits.

  • Replacement feeding with properly prepared formula or pasteurized donor human milk from a milk bank eliminates the risk of postnatal HIV transmission to the infant.

  • For mothers who are not on ART and/or do not have a suppressed viral load at delivery, replacement feeding with formula or pasteurized donor human milk is recommended to ensure no risk of transmission.

Moving Forward with Hope

As you explore your feeding options, remember that you’re not alone. With today’s treatments and growing knowledge, mothers are able to make choices that feel safe, nurturing, and aligned with their values. Whatever path you choose, there is real hope—hope grounded in science, in excellent health outcomes, and in the strength you bring to caring for your baby. We are here to support you every step of the way.

Disclaimer: Our classes and accompanying materials are intended for general education purposes and should not replace medical advice. For personalized recommendations, please consult your healthcare provider and/or lactation consultant.