Woman holding her baby and wondering if HIV can be transmitted through breast milk

Can HIV Be Transmitted Through Breast Milk?

Written on November 29, 2023 by Amy Harris, MPH, RN. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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In 2018, women accounted for about 1 in 5 (19%) new HIV diagnoses in the U.S. Of the 1.1 million people living in the United States with HIV, 258,000 (23%) are women.[1] You may have wondered, "Can HIV be transmitted through breast milk?" Worldwide, transmission of HIV-1 through breastfeeding is responsible for more than half of new pediatric HIV infections.[2] Treatment for HIV (with antiretroviral therapy or ART) substantially reduces the risk of perinatal transmission.[3] The development of effective HIV medications has made breastfeeding the healthiest option for many new mothers and their babies with access to these treatments.

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What Is HIV?

HIV stands for human immunodeficiency virus. It is a virus that attacks your body’s immune system, making it easier to get sick with many other infections. HIV spreads through contact with bodily fluids (including breastmilk) from someone infected with HIV, such as through sexual activity or through sharing injection drug equipment, such as needles or syringes.[4]

There is no cure for HIV. Once people get HIV, they have it for life. People with HIV who get effective HIV treatment with ART can live long, healthy lives and protect their partners.[5] HIV and AIDS are similar but not the same. If untreated, HIV can progress to Acquired Immune Deficiency Syndrome (AIDS) and eventually death.[6]

How Is HIV Transmitted Through Breast Milk?

Transmission of HIV from a pregnant person to their baby is called perinatal transmission. Perinatal transmission can happen during pregnancy, during childbirth, or when breastfeeding.[7]

The amount of virus a person with HIV has in their blood and breast milk is called their viral load. The higher your viral load, the greater the chance that you give your baby HIV through breastfeeding. Breast milk can transmit a virus that is already inside of your cells (called cell-associated HIV) and virus circulating freely in your breastmilk (cell-free HIV).[8]

If taken as prescribed, taking HIV medicine can reduce the amount of HIV in your body and breast milk to very low levels. ART aims to lower viral loads to levels at which the virus can not be detected (viral suppression). People with HIV who have undetectable viral loads may be able to breastfeed more safely. The risk of transmitting HIV through breast milk is not zero, even if your viral levels are undetectable.[8]

The U.S Centers for Disease Control (CDC) reports that for mothers on antiretroviral therapy (ART) with a sustained undetectable HIV viral load during pregnancy, the risk of transmission through breastfeeding is less than 1%, but not zero.[3]

Can HIV-Positive People Still Breastfeed?

Yes, but choosing to do so may be a complicated decision. Recommendations for breastfeeding with HIV are complex and vary depending on who you ask or what you read. Your access to affordable, clean water, formula or donor milk, ART, and healthcare also influences whether breastfeeding is the best option if you are living with HIV [9].

If you are managing HIV in pregnancy, your pregnancy and HIV care team should discuss whether or not you should breastfeed. Over time, breastfeeding recommendations have changed to advocate for breastfeeding if the breastfeeding parent is taking ART to suppress their viral load.

For example, The World Health Organization (WHO) released guidelines in July 2016 advising that mothers living with HIV who are on ART and who take their medications as directed should breastfeed exclusively for the first six months. They should then add complementary feeding until 12 months of age. Breastfeeding with complementary feeding may continue until 24 months of age or beyond. Previously, WHO advice was to breastfeed for 12 months but then stop breastfeeding if a nutritionally adequate and safe diet could be provided.[11]

In the United States, with consistent ART and monitoring, La Leche League encourages exclusive breastfeeding with support from lactation professionals for the first six months.[12] In contrast, The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) both advise against breastfeeding for mothers with HIV because properly prepared formula or pasteurized human donor milk from a milk bank eliminates the risk of HIV transmission to the infant of a person with HIV entirely. A January 2023 update from the National Institute of Health’s Office of AIDS Research called for shared decision-making between a person with HIV wanting to breastfeed and their healthcare team, given the overwhelming health benefits of breastfeeding and the low risk of transmission if you are taking ART.[9]

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What Are the Health Benefits of Breastfeeding, Even if You Have HIV?

Most of us have probably heard the expression “breast is best.” Some of the advantages that breastmilk has over formula feeding for infants are [7]:

  • Breastmilk has the perfect mix of ideal infant nutrition—its composition even changes to meet your growing baby’s nutritional needs
  • Breastfeeding reduces your risk for postpartum depression
  • It is cheaper and more convenient—you can breastfeed anywhere and whenever
  • It protects babies against short and long-term illnesses
  • Breastfeeding can reduce your risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure

If you have HIV and are taking ART, mixing formula feeding with breastfeeding may also be an option, according to WHO recommendations. Although healthcare providers recommend exclusive breastfeeding (no formula) for the first six months, mixed feeding is better than no breastfeeding. Exclusively breastfeeding your infant for at least six months will help them become sick less often and help them grow and develop to their fullest potential.[11]

Knowing Your HIV Status Can Prevent Transmission to Your Baby

Despite the minimal risk of HIV transmission from mother to baby through breastfeeding, public health agencies and healthcare providers worldwide advocate treating mothers with medications and allowing them to breastfeed. Everlywell can help you avoid getting HIV during pregnancy or while breastfeeding.

HIV Testing Kit

Everlywell offers a discreet at-home HIV testing kit. Public health officials and the American College of Obstetricians and Gynecologists (ACOG) all recommend that every pregnant person be tested for HIV at the start of their pregnancy.[13] Some people may know before their pregnancy that they are HIV positive. While the exact number of people giving birth with HIV in the United States is not known, the CDC estimates that the number is smaller than 5,000 people.[10] Early detection of HIV among pregnant women is critical to preventing transmission of HIV to the next generation, so this kit makes testing easy, confidential, and accessible.

Virtual Visits

Everlywell offers telehealth STI consults in two hours or less. Do you think you may have been exposed to HIV? Not sure if you are pregnant? Clinicians are available in select states Monday-Friday, 7 a.m.-6 p.m. CST (Age 18+) to talk with you about your options for STI testing.

Everlywell and our team of highly trained healthcare providers want you to experience a new kind of women’s health and sexual health care that is accessible, convenient, and available from the comfort and privacy of your own home. Call to schedule your appointment or order your STI tests today.

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Amy Harris is a certified nurse midwife, and registered nurse, and holds a master's degree in Maternal and Child Health from Harvard School of Public Health. She worked in clinical settings, medical practices, and reproductive health clinics for over 10 years.

References

  1. Women and HIV in the United States. Kaiser Family Foundation. https://www.kff.org/hivaids/fact-sheet/women-and-hivaids-in-the-united-states/. Published March 9, 2020. Accessed November 12, 2023.
  2. Philippe Van de Perre et al., HIV-1 Reservoirs in Breast Milk and Challenges to Elimination of Breast-Feeding Transmission of HIV-1.Sci. Transl. Med.4,143sr3-143sr3(2012).DOI:10.1126/scitranslmed.3003327.
  3. Human Immunodeficiency Virus (HIV): Breastfeeding. CDC. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/hiv.html. Published February 2, 2023. Accessed November 12, 2023.
  4. How is HIV transmitted? HIV.gov. https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/how-is-hiv-transmitted/. Published January 16, 2023. Accessed November 12, 2023.
  5. What are HIV and AIDS? HIV.gov. https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids/. Published January 13, 2023. Accessed November 12, 2023.
  6. About HIV. CDC. https://www.cdc.gov/hiv/basics/whatishiv.html. Published June 30, 2022. Accessed November 12, 2023.
  7. Breastfeeding benefits both the baby and the mom. CDC, Division of Nutrition, Obesity, and Physical Activity. https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html. Published September 7, 2023. Accessed November 12, 2023.
  8. Goga A E, Van de Perre P, Ngandu N, Nagot N, Abrams E J, Moodley D et al. Eliminating HIV transmission through breast milk from women taking antiretroviral drugs BMJ 2021; 374 :n1697 doi:10.1136/bmj.n1697.
  9. Update to clinical guidelines for infant feeding supports shared decision making: Clarifying breastfeeding guidance for people with HIV. Office of AIDS Research, NIH. https://oar.nih.gov/news-and-updates/oar-updates/update-clinical-guidelines-infant-feeding-supports-shared-decision-making. Published January 31, 2023. Accessed November 13, 2023.
  10. HIV and perinatal transmission: The numbers. CDC. https://www.cdc.gov/hiv/group/pregnant-people/numbers.html. Published September 30, 2023. Accessed November 12, 2023.
  11. HIV/AIDS: Infant feeding and nutrition. WHO. https://www.who.int/news-room/questions-and-answers/item/hiv-aids-infant-feeding-and-nutrition. Published November 21, 2021. Accessed November 12, 2023.
  12. Morrison, P. Update on HIV and Breastfeeding. International La Lache League. https://llli.org/news/update-on-hiv-and-breastfeeding-public/. Published April 4, 2019. Accessed November 13, 2023.
  13. Prenatal and Perinatal Human Immunodeficiency Virus Testing. ACOG Committee Opinion, 752. Affirmed 2020. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/09/prenatal-and-perinatal-human-immunodeficiency-virus-testing. Accessed November 13, 2023.
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