HIV and infant feeding

Mothers known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status) should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary foods thereafter, and continue breastfeeding.

Mothers living with HIV should breastfeed for at least the first 12 months and may continue breastfeeding for up to 24 months or beyond (similar to the general population) while being fully supported for Anti-retroviral therapy (ART) adherence (see the WHO Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection for interventions to optimize adherence)

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HIV and Infant Feeding:

Mother-to-child transmission of HIV is the primary mode of HIV infection in infants. Transmission can occur during pregnancy, birth, or through breastfeeding. Decisions on whether or not HIV-infected mothers should breastfeed their infants is generally based on comparing the risk of infants acquiring HIV through breastfeeding. This may also increase the risk of death from malnutrition, diarrhoea and pneumonia if the infants are not exclusively breastfed, especially where mothers do not meet the following conditions for safe replacement feeding:

  1. safe water and sanitation are assured at the household level and in the community, and, the mother, or other caregiver can reliably provide sufficient infant formula milk to support normal growth and development of the infant,
  2. The mother or caregiver can prepare it cleanly and frequently enough so that it is safe and carries a low risk of diarrhoea and malnutrition, and
  1. the mother or caregiver can, in the first six months, exclusively give infant formula milk, and,
  2. the family is supportive of this practice, and,
  3. the mother or caregiver can access health care that offers comprehensive child health services.

Accumulating evidence has shown that giving antiretroviral medicines to the mother or the infant can significantly reduce the risk of HIV transmission through breastfeeding. National health authorities can refer to this evidence when formulating a strategy on infant feeding.

WHO recommendations

Mothers known to be HIV-infected should be provided with lifelong antiretroviral therapy or antiretroviral prophylaxis interventions to reduce HIV transmission through breastfeeding.

National or sub-national health authorities should decide whether health services will principally counsel mothers known to be HIV-infected to either breastfeed and take antiretrovirals, or, avoid all breastfeeding.

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Protecting Breastfeeding during COVID-19

Mother and infant should still be enabled to remain together while rooming-in throughout the day and night and to practice skin to skin contact (including kangaroo mother care), whilst establishing breastfeeding. The mother should adhere to Covid-19 protocols. There is no evidence of transmission of COVID-19 in breastmilk.

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Breastfeeding protects new-borns from getting sick and also helps protect them throughout their infancy and childhood. Breastfeeding is particularly effective against infectious diseases because it strengthens the immune system by directly transferring antibodies from the mother. As with all confirmed or suspected COVID-19 cases, mothers with any symptoms who are breastfeeding or practicing skin-to-skin contact should take precautions. (Source WHO).

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