US pediatricians allow HIV-positive mothers to breastfeed under new guidelines

Sign for nursing room in a commercial building in San Ramon, California, November 21, 2019. Many retails and offices are providing dedicated rooms for nursing or breastmilk pumping by mothers. (Photo by Smith Collection/Gado/Getty Images)

U.S. pediatricians are reversing a decades-old policy and are giving the greenlight for people with HIV to breastfeed their babies, as long as they are taking medications that effectively suppress the virus that causes AIDS. 

The American Academy of Pediatrics' latest move came in the form a new report, reversing recommendations it had in place since the start of the HIV epidemic in the 1980s.

Medical experts said that routinely prescribed drugs can reduce the risk of transmitting HIV via breast milk to less than 1%.

"The medications are so good now and the benefits for mom and baby are so important that we are at a point where it is important to engage in shared decision-making," Dr. Lisa Abuogi, a pediatric HIV expert at the University of Colorado, said,

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The drugs, known as antiretroviral therapy, don’t eliminate all risk of transmitting HIV through breast milk. Avoiding breastfeeding is the only certain way to prevent spreading the virus, Abuogi said.

In addition, parents must breastfeed exclusively for the babies' first six months because research shows that switching between breast milk and formula can disrupt an infant's gut in ways that increase the risk of HIV infection.

About 5,000 people who have HIV give birth in the U.S. each year. Nearly all take drugs to suppress the virus to very low levels, Abuogi said, though viral levels can rebound if they don't stay on them.

The AAP policy comes more than a year after the National Institutes of Health and the Centers for Disease Control and Prevention reversed longstanding recommendations against breastfeeding by people with HIV. That guidance said people who have consistent viral suppression should be counseled on their options. It also emphasizes that health care providers shouldn't alert child protective services agencies if a parent with HIV seeks to breastfeed.

Breastfeeding provides ideal nutrition for babies and protects them against illnesses and conditions such as obesity and Type 2 diabetes, research shows. Nursing also reduces the mother’s risk of breast and ovarian cancer, diabetes and high blood pressure.

The World Health Organization has recommended since 2010 that women with HIV in developing countries breastfeed their infants and have access to antiretroviral therapy. The guidance weighed the risk of infants acquiring HIV through breastfeeding and the risk of babies dying from malnutrition, diarrhea and pneumonia in places where safe replacements for breast milk aren't available.

In developed nations, however, experts had recommended against breastfeeding because the wide availability of safe water, formula and human donor milk could eliminate the risk of HIV transmission, Yee said.

Abuogi said the AAP report provides crucial guidance for pediatricians, nurses and lactation specialists who work directly with children and families.

Some providers were already helping people treated for HIV to nurse their babies, despite the earlier recommendations. The new guidance should expand the practice, hopefully quickly, Abuogi said.

"This is a unique situation because it’s not just doctors and providers who are changing," Abuogi said. "Our patients are pushing this as well."

The Associated Press contributed to this report. This story was reported from Los Angeles.