UK guidelines

In the UK, as in other developed-world countries, where safe infant feeding alternatives are available (and free for women in need), women with HIV are strongly advised against breastfeeding their babies, regardless of maternal therapy, viral load or disease status.¹

From birth, exclusive feeding with infant formula milk is recommended.²

UK guidance has been reviewed in the light of data showing the protective effect of ART during breastfeeding.

“BHIVA/CHIVA acknowledge that, in the UK, the risk of mother-to-child transmission through exclusive breastfeeding from a woman who is on HAART and has a consistently undetectable HIV viral load is likely to be low but emphasise that this risk has not yet been quantified. Therefore, avoidance of breastfeeding is still the best and safest option in the UK to prevent mother-to-child transmission of HIV.”

In order to support women to formula feed, BHIVA and CHIVA recommend practical and financial measures to enable those on low incomes to be able to access formula milk and appropriate equipment. This includes specific measures for women subject to immigration control.¹

Whereas an HIV-positive mother’s decision to breastfeed has in the past been treated as a child protection issue, BHIVA and CHIVA do not consider this now to always be appropriate.

While not recommending that HIV-positive women breastfeed, BHIVA and CHIVA say that women who do so “should be supported to exclusively breastfeed as safely, and for as short a period, as possible”. This will involve:

• Monthly assessments of maternal viral load, side-effects and the infant’s HIV status.
• Continuation of maternal ART until one week after cessation of breastfeeding.
• No mixed feeding, except in the weaning period.
• Cessation of breastfeeding as early as possible, and no later than six months.
• Education around factors that increase transmission risk (e.g. mastitis).
• Resources to enable switching to alternative feeding methods.

It is not recommended that babies should be offered antiretroviral prophylaxis throughout the breastfeeding period, as data are lacking on the safety of this approach.