American Academy of Pediatrics Updates Recommendations on Infant Feeding for Persons Living With HIV

In a reversal from previous recommendations¹, the American Academy of Pediatrics (AAP) published new guidance supporting breastfeeding for people with HIV who have consistently been taking antiretroviral therapy (ART) and have sustained viral suppression below 50 copies per mL.²

“People with HIV may express a desire to breastfeed, and pediatricians should be prepared to offer a family-centered, nonjudgmental, harm reduction approach to support people with HIV on ART with sustained viral suppression below 50 copies per mL who desire to breastfeed,” the authors wrote in their report.

The newly published AAP report, “Infant Feeding and Transmission of Human Immunodeficiency Virus in the United States” written by Abuogi and colleagues, offers guidance for pediatricians and pediatric health professionals who care for infants born to people living with and at risk for HIV infection. These health care professionals will likely be involved in conversations on recommended feeding practices.

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“Care team members need to be aware of the HIV transmission risk from breastfeeding and the recommendations for feeding infants with perinatal HIV exposure in the United States,” the authors wrote.

While the authors note that avoiding breastfeeding is the only feeding option that eliminates the risk of HIV transmission entirely, it is also true that HIV transmission through breastfeeding from a parent with HIV who receives ART and is virally suppressed is estimated to be less than 1%.

In their guidance, Abuogi and colleagues recommend against breastfeeding in people with HIV who are not on ART or who are on ART but do not have viral suppression. The report also reiterates the importance of HIV testing for pregnant individuals.

“Pediatric health care professionals should recommend HIV testing for all pregnant persons and HIV preexposure prophylaxis to pregnant or breastfeeding persons who test negative for HIV but are at high risk of HIV acquisition,” the authors conclude in their report.

References

1. Mofenson LM, Flynn PM, Aldrovandi GM, et al; Committee On Pediatric Aids. Infant feeding and transmission of human immunodeficiency virus in the United States. Pediatrics. 2013;131(2):391–396. doi:10.1542/peds.2012-3543
2. Abuogi L, Noble L, Smith C, et al; Committee on pediatric and adolescent HIV. Infant feeding for persons living with and at risk for HIV in the United States: clinical report. Pediatrics. Published May 20, 2024. Accessed May 28, 2024. doi:10.1542/peds.2024-066843