It’s no surprise that myHIVteam members have questions about whether they can breastfeed while human immunodeficiency virus (HIV)-positive. “I’m hoping that as good as I’m doing with maintaining undetectable viral loads and a high CD4 count, I would be able to breastfeed my newborn,” one member wrote. “Are there any options for people who are HIV-positive and undetectable?”

HIV damages the immune system and can lead to AIDS, a serious condition that can develop in people who have the virus. Fortunately, with proper treatment and care, people living with HIV can lead healthy and fulfilling lives. For people living with HIV who are considering pregnancy, many options are available to help them have healthy pregnancies and children. However, when it comes to breastfeeding, it is important to be aware of the potential risks and make an informed decision.

Deciding whether to breastfeed as a parent living with HIV can be a complex and challenging decision. You’ll need to carefully consider the risks and benefits. The following are some important factors to consider.

1. Breastfeeding Is Good for You and Your Baby

Breastfeeding provides many health benefits for both you and your baby. In fact, the Centers for Disease Control and Prevention (CDC) generally recommends that parents (without HIV) exclusively breastfeed their babies up until the age of 6 months. Because you pass antibodies on to your baby through breast milk, breastfeeding can help your baby fight off some infections.

Additionally, breastfed infants have a lower risk of sudden infant death syndrome (SIDS), asthma, obesity, and type 1 diabetes. For the parent, breastfeeding decreases the chance of developing type 2 diabetes, high blood pressure, and some types of cancer.

Finally, breastfeeding can also help strengthen the bond between parents and their baby. Skin-to-skin contact and the act of nursing can provide comfort and security for the baby and reduce stress and promote relaxation for you. Your health care professionals can help you weigh the risks and benefits to decide whether exclusive breastfeeding is an option for your baby.

2. HIV Can Be Spread Through Breast Milk

Breastfeeding is a potential route of transmission for HIV, which means a parent who is HIV-positive is at risk of transmitting the virus to their infant through breast milk. The risk of transmission depends on various factors, such as the duration of breastfeeding and the levels of HIV in the parent’s body.

HIV cannot be transmitted through casual contact, such as hugging, kissing, or sharing utensils. The virus can be transmitted only through bodily fluids, including blood, semen, vaginal fluids, and breast milk.

3. Your Baby May Need Antiretroviral Treatment

Babies who are born to HIV-positive mothers and are also breastfed are at risk of contracting HIV through breast milk. To reduce the risk of transmission, health experts recommend that these babies receive antiretroviral treatment (ART) as a preventive measure. Your doctor may call this antiretroviral prophylaxis.

In addition to recieving ART, babies breastfed by a parent who’s HIV-positive should be closely monitored by health care professionals to ensure they’re healthy and developing normally. Regular check-ups and HIV testing can help identify any potential problems early and ensure that the baby receives prompt treatment if needed.

Managing ART for a baby can be challenging, but it’s a crucial step in protecting their health and reducing the risk of HIV transmission.

4. There Are Other Options for Feeding Your Baby

There are several feeding options available for parents who are HIV-positive and choose not to breastfeed or are advised against it. These choices include formula feeding, donor breast milk, combination feeding, and flash heating.

Formula Feeding

Formula feeding is a safe and effective option for feeding your baby if you decide not to breastfeed. With formula feeding, the risk of giving your baby HIV through food is virtually eliminated. Commercial infant formula is nutritionally complete and can provide all of the nutrients your baby needs to grow and develop.

It is important to prepare and store formula correctly to reduce the risk of contamination with harmful bacteria. Your health care provider can provide guidance on how to safely and effectively formula feed your baby.

Donor Breast Milk

Using donor breast milk may be another option if you choose not to breastfeed. Donor breast milk refers to milk donated by other lactating parents, and it’s screened for HIV and other infections. It is also often pasteurized, like store-bought cow’s milk, to destroy any potential infectious diseases like HIV or hepatitis. However, donor breast milk can be expensive, and the supply for milk banks is not guaranteed.

Combination Feeding

Combination feeding, or mixed feeding, involves both breastfeeding and formula feeding. This may be an option for some parents who have a positive HIV status, undetectable viral loads through pregnancy, and want to breastfeed but cannot exclusively breastfeed because of a lack of supply.

Combination feeding may help reduce the risk of transmitting HIV through breast milk while still providing some of the health benefits of breastfeeding. Mixed feeding might be necessary if your milk supply runs low or if your baby is not gaining enough weight.

However, it is important to discuss the risks and benefits of combination feeding with your health care provider, as this may not be appropriate in all situations.

Flash Heating

Studies show that heating breast milk quickly after pumping can eliminate most HIV from breast milk. This is called flash heating. Flash heating may be useful if you do not have any other options to feed your baby. If your nipples are bleeding or if you develop mastitis (an infection in your breast), ask your doctor if flash heating your breast milk is a safe option.

5. Personal Factors May Affect Your Decision To Breastfeed

The decision to breastfeed should be made in consultation with a health care provider, taking into account individual circumstances and preferences.

Factors to consider include:

• Your health status
• Your baby’s health status
• Your mental and emotional well-being
• Your ability to adhere to ART
• The availability of other feeding options

You may also have other personal considerations when deciding whether or not to breastfeed. Some parents may face a cultural expectation to breastfeed their baby and may worry that deciding not to breastfeed may let others know that they are HIV-positive. Formula may be too expensive or not available in your area.

6. Parents With Undetectable Viral Loads Can Breastfeed With Minimal Risk

Before you decide on breastfeeding, you should have your viral load tested. Viral load is the amount of HIV in your blood. If your viral load is high, there is an increased risk that your baby will be infected with HIV through breast milk. The CDC recommends that people shouldn’t breastfeed if their viral loads weren’t low throughout pregnancy (at least through the third trimester) and during delivery.

On the other hand, if your viral load is undetectable — meaning your blood contains very low levels of HIV — the risk of transmitting HIV to your baby is greatly reduced. It is important to receive HIV treatment such as ART during and after pregnancy to reduce the risk of parent-to-child transmission of HIV.

Some parents might be worried about exposing their baby to ART medicines through their breast milk. Studies show that the levels of ART medication found in breast milk are lower than in their blood, and the risk of side effects for babies on ART or breastfeeding from a parent on ART is low.

If you develop detectable viral loads, it is recommended to stop breastfeeding immediately.

If you’re on ART and had an undetectable viral load during pregnancy, the risk of giving your baby HIV through breastfeeding is less than 1 percent, according to the CDC. This is still a risk higher than zero — and because HIV is a lifelong disease, some people may find this risk to be too high. As more people with HIV breastfeed while on ART, researchers are gathering more data to determine if it is safe.

7. Your Health Care Providers Are Your Best Resource

Your health care providers, including your HIV care team, OB-GYN, and lactation support provider are your best resources when it comes to managing your HIV and pregnancy/post-pregnancy. They can provide guidance on reducing your viral load, choosing the best feeding option for your baby, and preventing the transmission of HIV to your baby. With proper care and treatment, people living with HIV can have healthy pregnancies and raise healthy children.

It’s important to be honest with your health care providers about your HIV status and your plans for feeding your infant. Your doctor might not be aware of the latest CDC recommendations for breastfeeding while HIV-positive. If this is the case, you can refer them to the national Perinatal HIV/AIDS hotline (1-888-448-8765).

Talk With Others Who Understand

On myHIVteam, the social network for people with HIV, and their loved ones, more than 37,000 members come together to ask questions, give advice, and share their stories with others who understand life with HIV.

Are you living with HIV and considering breastfeeding your baby? Share your experience in the comments below, or start a conversation by posting on your Activities page.