Use of ART while breastfeeding

Although breastfeeding from an HIV-positive mother poses a risk of HIV transmission to the infant, this must be weighed against the risks of infant malnutrition, infections and mortality posed by formula-feeding – and whether acceptable, feasible, affordable, sustainable and safe alternatives to breastfeeding are available.

Providing antiretroviral therapy (ART) to the mother, the infant or both during the breastfeeding period can significantly reduce the risk of HIV transmission through breastfeeding. Several such strategies have been evaluated in clinical studies, as detailed in the remainder of this section. In HIV-positive breastfeeding mothers, ART results in reduced viral loads in breast milk, as well as drug levels in breast milk that should be sufficient to prevent HIV transmission. As described in the last section, exclusive breastfeeding also presents a lower risk of transmission than mixed feeding.

The WHO currently endorses an "either-or" approach based on available resources: HIV-positive mothers with infants who are HIV-uninfected (or whose status is unknown) should either:

  • avoid breastfeeding altogether, or
  • breastfeed with accompanying prophylactic ART to lower the risk of HIV transmission.

If breastfeeding, the infant should be exclusively breastfed for the first six months, introducing appropriate complementary foods after that while continuing breastfeeding until 12 months of age. Breastfeeding should stop only once a nutritionally adequate and safe diet without breast milk can be provided.

HIV-positive mothers of HIV-infected infants are strongly encouraged to exclusively breastfeed for the first six months and continue breastfeeding as recommended for the general population, that is, up to two years or beyond.

The following section presents information from studies that have looked at the strategies of short-term breastfeeding with maternal ART, breastfeeding or formula feeding after short-term ART, extended ART for breastfeeding mothers, and extended infant post-exposure prophylaxis. 

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.