The American Academy of Pediatrics has changed its position on breast feeding and HIV, issuing updated guidelines.

The new guidelines highlight the risk for HIV transmission through breastfeeding, even with viral suppression and antiretroviral therapy (ART). To “completely eliminate” the risk of postnatal HIV transmission, the AAP recommended formula feeding or using certified, banked donor human milk.

However, for those with HIV on ART with a sustained viral suppression under 50 copies per mL who express a strong desire to breastfeed, health care professionals are encouraged to adopt a nonjudgmental, harm-reduction approach. This includes counseling on the risks and benefits of feeding options (breastfeeding, formula, or certified, banked donor milk), ensuring the individual maintains viral suppression with ART, and providing infant antiretroviral (ARV) prophylaxis.

"The health care team should maintain frequent and open communication with breastfeeding parents with HIV to facilitate safer breastfeeding and provide ongoing monitoring for complications during the breastfeeding period,” according to the clinical report authors.

Also, pregnant and postpartum patients who do not have HIV but are considered high risk for HIV acquisition should receive frequent HIV testing (every 3 months) and preexposure prophylaxis (PrEP) should be offered.

In cases where breastfeeding is chosen despite the risks, exclusive breastfeeding for the first 6 months is advised, along with continuous ART for the individual and infant ARV prophylaxis. Gradual weaning over 2 to 4 weeks is recommended to minimize the risk of HIV transmission.

The authors reported having no potential conflicts of interest to disclose.