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, with the increased risk of death from malnutrition, diarrhoea and pneumonia if the infants are not exclusively breastfed.
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.
In settings where national health authorities are recommending breastfeeding for HIV-infected mothers:
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 breast feeding.
Mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or longer (similar to the general population) while being fully supported for ART adherence (see the WHO Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection for interventions to optimize adherence).
In settings where health services provide and support lifelong ART, including adherence counselling, and promote and support breastfeeding among women living with HIV, the duration of breastfeeding should not be restricted.
Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided.
National and local health authorities should actively coordinate and implement services in health facilities and activities in workplaces, communities and homes to protect, promote and support breastfeeding among women living with HIV.
Guidelines and guidance documents
Learn More 
GRC-approved guidelines
Other guidance documents
Evidence
Systematic reviews used to develop the guidelines
Postnatal HIV Transmission rates at age six and 12 months in infants of HIV-infected women on ART initiating breastfeeding: a systematic review of the literaturepdf, 908kb
pdf, 908kb Chikhungu L, Bispo S, Newell ML. Geneva: World Health Organization; 2016.
HIV-free survival at 12 – 24 months in breastfed infants of HIV-infected women on ART: a systematic reviewpdf, 949kb
pdf, 949kb Chikhungu L, Bispo S, Newell ML. Geneva: World Health Organization; 2016.
A systematic review of HIV-free survival by feeding practices from birth to 18 months: Annex 2pdf, 227kb
pdf, 227kb Chetty T, Naidu KK, Newell ML. Geneva: World Health Organization; 2010.
Individual evidence summaries of all studies included in the systematic review of HIV-free survival by infant feeding practices from birth to 18 – 24 months: Annex 5pdf, 803kb
pdf, 803kb Chetty T, Naidu KK, Newell ML. Geneva: World Health Organization; 2009.
An analysis of optimal breastfeeding durations for HIV-Exposed Infants: Assessing the impact of naternal ART use, infant mortality, and replacement feeding riskpdf, 1.02Mb
pdf, 1.02Mb Mallampati D, MacLean R, Ciaranello A. Geneva: World Health Organization; 2016.
Related Cochrane reviews
Interventions for preventing late postnatal mother-to-child transmission of HIV
Horvath T, Madi BC, Iuppa IM, Kennedy GE, Rutherford GW, Read JS. Cochrane Database of Systematic Reviews. 2009; Issue 1. Art. No.: CD006734.
Summary of this review
Cost-effectiveness analyses
Cost-effectiveness analysis of infant feeding strategies to prevent mother-to-child transmission of HIV in South Africa
Maredza M, Bertram MY, Saloojee H, Chersich MF, Tollman SM, Hofman KJ.
Afr J AIDS Res. 2013; 12(3):151-60.
The cost-effectiveness of different feeding patterns combined with prompt treatments for preventing mother-to-child HIV transmission in South Africa: estimates from simulation modeling
Yu W, Li C, Fu X, Cui Z, Liu X, Fan L et al.
PLoS One. 2014; 9(7):e102872.
Scaling-up exclusive breastfeeding support programmes: the example of KwaZulu-Natal
Desmond C, Bland RM, Boyce G, Coovadia HM, Coutsoudis A, Rollins N, Newell ML.
PLoS One. 2008; 3(6):e2454.
Prevention of Mother-To-Child Transmission of HIV: Cost-Effectiveness of Antiretroviral Regimens and Feeding Options in Rwanda
Binagwaho A, Pegurri E, Drobac PC, Mugwaneza P, Stulac SN, Wagner CM et al.
PLoS One. 2013; 8(2):e54180.
