Last update Oct. 30, 2023

Maternal HIV-AIDS. Maternal HIV infection

Low Risk

Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

The Human Immunodeficiency Virus (HIV) is a retrovirus that destroys lymphocytes and other cells responsible for the immune (defensive) system of people, making infections and other immune diseases possible.  Acquired Immune Deficiency Syndrome (AIDS) is the final stage of HIV infection, in which the body's immune system is severely damaged by the virus. Not all people with HIV develop AIDS.
HIV is transmitted through bodily fluids:

  • In sexual intercourse 
  • Through blood: Sharing needles for drug use, transfusions and other contact with blood from an infected person.
  • From mother to child during pregnancy, childbirth or breastfeeding (BF).

Before the advent of Combination Anti-Retroviral Treatment (cART), the risk of Mother-to-Child Transmission (MTCT) of HIV through BF was 5 to 42% (White 2014). Prevention involves avoiding BF in regions or (developed) countries where the use of formula milk is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS). Otherwise, BF in mothers with HIV is preferable because of the higher morbidity and mortality resulting from feeding with BF substitutes. (García 2015)

The efficacy of cART proven in experiences with breastfeeding mothers in Nigeria and Zambia with IMT ≈ 0 (Ngoma 2015, Okafor2014), similar to that obtained (< 2%) when BF is avoided (Lolekha 2017), makes that since 2010 WHO has sufficient evidence to recommend as an option to maintain BF in mothers with HIV, provided it is ensured:
    - Lifelong cART follow-up and continuity (Option B+).
    - Monthly viral load controls (< 50 copies/ml).
    - BF pumping and warming in special cases

Since 2016, WHO breastfeeding recommendations for HIV mothers who wish to breastfeed are the same as for non-HIV mothers (exclusive breastfeeding 6 months and then partial breastfeeding two or more years) as long as they take cART and continue viral load controls. Exclusive or non-exclusive breastfeeding and its duration do not influence IMR. Health authorities will provide cART and controls, and, depending on the country's possibilities will decide whether to discourage BF as a preventive measure. (WHO 2016)

Given the effectiveness of cART, that reduces viral load to undetectable or less than 40 copies/mL and prevents transmission, the campaign slogan Undetectable = Untransmissible (U =U) has been imposed as a paradigm in sexual transmission. (Rodger 2019 and 2016, The Lancet HIV 2017)

But there are doubts whether U = U is valid for transmission through LM (Kahlert 2018, Waitt 2018), as cART suppresses HIV RNA from milk, but not the virus (DNA) associated with CD4+ T cells present in LM (Prendergast 2019, Van de Perre 2012). However, it is known that with HIV-DNA in vaginal secretions and zero viral load, there is no horizontal transmission. (Nelson 2020, Prazuck 2013)

Systematic reviews did not identify any cases of MTCT of HIV through BF in a defined "optimal scenario" (Kahlert 2018) setting: pregnant woman who has adherence to taking her cART, regular clinical care, and HIV viral load of <50 copies RNA/ml during pregnancy and breastfeeding). The general recommendation in developed countries to criminalize or outlaw BF in mothers with HIV may no longer be warranted; a shared decision-making process and support for mothers with HIV who choose to breastfeed, ensuring cART uptake and viral load checks is advocated. (Symington 2022, Wagner 2020, Agwu 2020, Tuthill2019, Kahlert 2018)

Several developed countries (Switzerland, Germany, Great Britain, United States, Italy), still recommending avoidance of BF as the most effective measure to prevent MTCT of HIV, have changed their guidelines to support HIV-positive people who choose to breastfeed, receive cART and have a sustained undetectable viral load. (HHS Panel 2023, Gilleece 2019, Kahlert 2018)

In these countries, dozens of HIV-positive mothers (25 in Switzerland, 44 in the United States, 28 in Canada. 30 in Germany, 13 in Italy, ) have breastfed and HIV detection in infants has been negative months after the end of breastfeeding. (Crisinel 2023, Levison 2023, Weiss 2022, Prestileo 2022)

Policies that maximize the rate of diagnosis of HIV-infected persons and prophylaxis in serodiscordant cases (HIV seronegative mother with HIV partner) are needed to decrease the cases of MTCT that occur when the mother is infected during infancy. (Anderson 2020, Tan 2017, WHO 2017 & 2014)

The most commonly used combination of ART is the association of two nucleoside analogue reverse transcriptase inhibitors (NRTIs) with a ritonavir-boosted protease inhibitor (PI/r) or an integrase inhibitor (II): 2 NRTIs + 1 PI/r or 1 II. (HSJD-HC 2023, Nelson 2014)

ARTs are excreted in very low amounts in BF, with a relative dose of less than 10%, and are very well tolerated by infants  (Aebi-Popp 2022, Kapito 2021, Mugwanya 2017 & 2016, Palombi 2016). Concern may be raised about the possible development of resistance if HIV infection occurs in the infant. (Aebi-Popp 2022)


See below the information of these related products:

  • Abacavir (ABC) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Amprenavir (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)
  • Atazanavir Sulfate (ATV) (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)
  • Darunavir (DRV) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Dolutegravir (DTG) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Efavirenz (EFV) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Emtricitabine (FTC) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Lamivudine (3TC) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Lopinavir / Ritonavir (LPV /r) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Nevirapine (NVP) (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)
  • Raltegravir (RAL) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Tenofovir (TAF / TDF) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Zidovudine (ZDV / AZT) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Maternal HIV-AIDS. Maternal HIV infection is also known as


Group

Maternal HIV-AIDS. Maternal HIV infection belongs to this group or family:

References

  1. HSJD-HC. Hospital Sant Joan de Deu, Hospital Clínic de Barcelona. VIH y gestación. Protocolos en patología médica y obstétrica. 2023 Consulted on Aug. 21, 2023 Full text (link to original source)
  2. Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States. Department of Health and Human Services. 2023 Consulted on June 16, 2023 Abstract Full text (link to original source)
  3. Li G, Wang Y, De Clercq E. Approved HIV reverse transcriptase inhibitors in the past decade. Acta Pharm Sin B. 2022 Apr;12(4):1567-1590. Consulted on Dec. 16, 2022 Abstract Full text (link to original source)
  4. Aebi-Popp K, Kahlert CR, Crisinel PA, Decosterd L, Saldanha SA, Hoesli I, Martinez De Tejada B, Duppenthaler A, Rauch A, Marzolini C; Swiss Mother and Child HIV Cohort Study (SHCS).. Transfer of antiretroviral drugs into breastmilk: a prospective study from the Swiss Mother and Child HIV Cohort Study. J Antimicrob Chemother. 2022 Nov 28;77(12):3436-3442. Consulted on Dec. 16, 2022 Abstract Full text (link to original source)
  5. Prestileo T, Adriana S, Lorenza DM, Argo A. From Undetectable Equals Untransmittable (U=U) to Breastfeeding: Is the Jump Short? Infect Dis Rep. 2022 Mar 25;14(2):220-227. Consulted on April 19, 2022 Abstract Full text (link to original source)
  6. Levison J, McKinney J, Duque A, Hawkins J, Bowden EVH, Dorland J, Bitnun A, Kazmi K, Campbell DM, MacGillivray J, Yudin MH, Powell A, Datta S, Abuogi L, Weinberg A, Rakhmanina N, Mareuil JW, Hitti J, Boucoiran I, Kakkar F, Rahangdale L, Seidman D, et al. Breastfeeding among people with HIV in North America: a multisite study. Clin Infect Dis. 2023 Apr 20. pii: ciad235. Abstract
  7. Crisinel PA, Kusejko K, Kahlert CR, Wagner N, Beyer LS, De Tejada BM, Hösli I, Vasconcelos MK, Baumann M, Darling K, Duppenthaler A, Rauch A, Paioni P, Aebi-Popp K. Successful implementation of new Swiss recommendations on breastfeeding of infants born to women living with HIV. Eur J Obstet Gynecol Reprod Biol. 2023 Apr;283:86-89. Abstract Full text (link to original source)
  8. Symington A, Chingore-Munazvo N, Moroz S. When law and science part ways: the criminalization of breastfeeding by women living with HIV. Ther Adv Infect Dis. 2022 Sep 8;9:20499361221122481. Abstract Full text (link to original source)
  9. Weiss F, von Both U, Rack-Hoch A, Sollinger F, Eberle J, Mahner S, Kaestner R, Alba Alejandre I. Brief Report: HIV-Positive and Breastfeeding in High-Income Settings: 5-Year Experience From a Perinatal Center in Germany. J Acquir Immune Defic Syndr. 2022 Dec 1;91(4):364-367. Abstract
  10. (Red Book). AAP. Kimberlin DW, Barnett ED, , Lynfield R, Sawyer MH eds. Red Book: 2021-2024. Report of the Committee on Infectious Diseases. 32th ed. Elk Grove Village, - 2021
  11. Van de Perre P, Molès JP, Nagot N, Tuaillon E, Ceccaldi PE, Goga A, Prendergast AJ, Rollins N. Revisiting Koch's postulate to determine the plausibility of viral transmission by human milk. Pediatr Allergy Immunol. 2021 Jul;32(5):835-842. Abstract Full text (link to original source)
  12. Kapito-Tembo AP, Bauleni A, Wesevich A, Ongubo D, Hosseinipour MC, Dube Q, Mwale P, Corbett A, Mwapasa V, Phiri S. Growth and Neurodevelopment Outcomes in HIV-, Tenofovir-, and Efavirenz-Exposed Breastfed Infants in the PMTCT Option B+ Program in Malawi. J Acquir Immune Defic Syndr. 2021 Jan 1;86(1):81-90. Abstract
  13. Agwu AL, Auerback JD, Cameron B, et al. Expert Consensus Statement on Breastfeeding and HIV in the United States and Canada. The Well Project. 2020 Full text (link to original source)
  14. Nelson JAE, De Paris K, Ramirez C, Edmonds A, Mollan KR, Bay CP, Compliment K, Herold BC, Anastos K, Minkoff H, Kassaye S, Seidman DL, French AL, Golub ET, Sheth AN, Ochsenbauer C, Swanstrom R, Eron JJ, Adimora AA. Female genital tract shedding of HIV-1 is rare in women with suppressed HIV-1 in plasma. AIDS. 2020 Jan 1;34(1):39-46. Abstract Full text (link to original source)
  15. Wagner N, Crisinel PA, Kahlert C, Martinez De Tejada B. [Breastfeeding for HIV-positive mothers in Switzerland : are we ready to discuss ?] Rev Med Suisse. 2020 Oct 28;16(712):2050-2054. Review. French. Abstract
  16. Anderson PO. Breastfeeding by Women with HIV Infection. Breastfeed Med. 2020 Aug;15(8):485-487. Abstract
  17. Gilleece DY, Tariq DS, Bamford DA, Bhagani DS, Byrne DL, Clarke DE, Clayden MP, Lyall DH, Metcalfe DR, Palfreeman DA, Rubinstein DL, Sonecha MS, Thorley DL, Tookey DP, Tosswill MJ, Utting MD, Welch DS, Wright MA. British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018. HIV Med. 2019 Mar;20 Suppl 3:s2-s85. Abstract Full text (link to original source)
  18. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Degen O, Corbelli GM, Estrada V, Geretti AM, Beloukas A, Raben D, Coll P, Antinori A, Nwokolo N, Rieger A, Prins JM, Blaxhult A, Weber R, Van Eeden A, Brockmeyer NH, Clarke A, Del Romero Guerrero J, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019 Jun 15;393(10189):2428-2438. Abstract Full text (link to original source)
  19. Prendergast AJ, Goga AE, Waitt C, Gessain A, Taylor GP, Rollins N, Abrams EJ, Lyall EH, de Perre PV. Transmission of CMV, HTLV-1, and HIV through breastmilk. Lancet Child Adolesc Health. 2019 Apr;3(4):264-273. Abstract
  20. Tuthill EL, Tomori C, Van Natta M, Coleman JS. "In the United States, we say, 'No breastfeeding,' but that is no longer realistic": provider perspectives towards infant feeding among women living with HIV in the United States. J Int AIDS Soc. 2019 Jan;22(1):e25224. Abstract Full text (link to original source)
  21. Waitt C, Low N, Van de Perre P, Lyons F, Loutfy M, Aebi-Popp K. Does U=U for breastfeeding mothers and infants? Breastfeeding by mothers on effective treatment for HIV infection in high-income settings. Lancet HIV. 2018 Sep;5(9):e531-e536. Abstract
  22. Kahlert C, Aebi-Popp K, Bernasconi E, Martinez de Tejada B, Nadal D, Paioni P, Rudin C, Staehelin C, Wagner N, Vernazza P. Is breastfeeding an equipoise option in effectively treated HIV-infected mothers in a high-income setting? Swiss Med Wkly. 2018 Jul 24;148:w14648. Abstract Full text (link to original source)
  23. Lolekha R, Chokephaibulkit K, Phanuphak N, Chaithongwongwatthana S, Kiertiburanakul S, Chetchotisakd P, Boonsuk S; Thai national prevention of mother-to-child transmission (PMTCT) Guidelines Working Group.. Thai national guidelines for the prevention of mother-to-child transmission of human immunodeficiency virus 2017. Asian Biomed (Res Rev News). 2017 Apr;11(2):145-159. Abstract
  24. Tan DHS, Hull MW, Yoong D, Tremblay C, O'Byrne P, Thomas R, Kille J, Baril JG, Cox J, Giguere P, Harris M, Hughes C, MacPherson P, O'Donnell S, Reimer J, Singh A, Barrett L, Bogoch I, Jollimore J, Lambert G, Lebouche B, Metz G, et al. Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. CMAJ. 2017 Nov 27;189(47):E1448-E1458. Abstract Full text (link to original source) Full text (in our servers)
  25. Mugwanya KK, John-Stewart G, Baeten J. Safety of oral tenofovir disoproxil fumarate-based HIV pre-exposure prophylaxis use in lactating HIV-uninfected women. Expert Opin Drug Saf. 2017 Abstract Full text (link to original source)
  26. The Lancet HIV. U=U taking off in 2017. Lancet HIV. 2017 Nov;4(11):e475. Abstract Full text (link to original source)
  27. WHO - World Health Organization Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Guideline. 2016 Abstract Full text (link to original source) Full text (in our servers)
  28. Davis NL, Miller WC, Hudgens MG, Chasela CS, Sichali D, Kayira D, Nelson JA, Fiscus SA, Tegha G, Kamwendo DD, Rigdon J, Stringer JS, Juliano JJ, Ellington SR, Kourtis AP, Jamieson DJ, van der Horst C; BAN study team.. Maternal and Breastmilk Viral Load: Impacts of Adherence on Peripartum HIV Infections Averted-The Breastfeeding, Antiretrovirals, and Nutrition Study. J Acquir Immune Defic Syndr. 2016 Dec 15;73(5):572-580. Abstract
  29. Mugwanya KK, Hendrix CW, Mugo NR, Marzinke M, Katabira ET, Ngure K, Semiyaga NB, John-Stewart G, Muwonge TR, Muthuri G, Stergachis A, Celum CL, Baeten JM. Pre-exposure Prophylaxis Use by Breastfeeding HIV-Uninfected Women: A Prospective Short-Term Study of Antiretroviral Excretion in Breast Milk and Infant Absorption. PLoS Med. 2016 Abstract Full text (link to original source) Full text (in our servers)
  30. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, Corbelli GM, Estrada V, Geretti AM, Beloukas A, Asboe D, Viciana P, Gutiérrez F, Clotet B, Pradier C, Gerstoft J, Weber R, Westling K, Wandeler G, Prins JM, Rieger A, Stoeckle M, et al. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA. 2016 Jul 12;316(2):171-81. Abstract Full text (link to original source)
  31. WHO / UNICEF. Updates on HIV and Infant Feeding: The Duration of Breastfeeding, and Support from Health Services to Improve Feeding Practices Among Mothers Living with HIV. Guideline. 2016 Abstract Full text (link to original source) Full text (in our servers)
  32. Palombi L, Pirillo MF, Marchei E, Jere H, Sagno JB, Luhanga R, Floridia M, Andreotti M, Galluzzo CM, Pichini S, Mwenda R, Mancinelli S, Marazzi MC, Vella S, Liotta G, Giuliano M. Concentrations of tenofovir, lamivudine and efavirenz in mothers and children enrolled under the Option B-Plus approach in Malawi. J Antimicrob Chemother. 2016 Abstract Full text (link to original source) Full text (in our servers)
  33. Garcia-Loygorri MC, De Luis D, Torreblanca B, March GA, Bachiller MR, Eiros JM. La leche materna como vehículo de transmisión de virus. [Beast Milk as vehicle of transmission of virus]. Nutr Hosp. 2015 Abstract Full text (link to original source) Full text (in our servers)
  34. Ngoma MS, Misir A, Mutale W, Rampakakis E, Sampalis JS, Elong A, Chisele S, Mwale A, Mwansa JK, Mumba S, Chandwe M, Pilon R, Sandstrom P, Wu S, Yee K, Silverman MS. Efficacy of WHO recommendation for continued breastfeeding and maternal cART for prevention of perinatal and postnatal HIV transmission in Zambia. J Int AIDS Soc. 2015 Jul 1;18:19352. Abstract Full text (link to original source)
  35. White AB, Mirjahangir JF, Horvath H, Anglemyer A, Read JS. Antiretroviral interventions for preventing breast milk transmission of HIV. Cochrane Database Syst Rev. 2014 Oct 4;(10):CD011323. Abstract
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  38. Okafor I, Ugwu E, Obi S, Odugu B. Virtual Elimination of Mother-to-Child Transmission of Human Immunodeficiency Virus in Mothers on Highly Active Antiretroviral Therapy in Enugu, South-Eastern Nigeria. Ann Med Health Sci Res. 2014 Jul;4(4):615-8. Abstract Full text (link to original source)
  39. Nelson LJ, Beusenberg M, Habiyambere V, Shaffer N, Vitoria MA, Montero RG, Easterbrook PJ, Doherty MC. Adoption of national recommendations related to use of antiretroviral therapy before and shortly following the launch of the 2013 WHO consolidated guidelines. AIDS. 2014 Abstract
  40. Prazuck T, Chaillon A, Avettand-Fènoël V, Caplan AL, Sayang C, Guigon A, Niang M, Barin F, Rouzioux C, Hocqueloux L. HIV-DNA in the genital tract of women on long-term effective therapy is associated to residual viremia and previous AIDS-defining illnesses. PLoS One. 2013 Aug 21;8(8):e69686. Abstract Full text (link to original source)
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  44. Van de Perre P, Rubbo PA, Viljoen J, Nagot N, Tylleskär T, Lepage P, Vendrell JP, Tuaillon E. HIV-1 reservoirs in breast milk and challenges to elimination of breast-feeding transmission of HIV-1. Sci Transl Med. 2012 Jul 18;4(143):143sr3. Abstract
  45. Azkune H, Ibarguren M, Camino X, Iribarren JA. Prevención de la transmisión del VIH (vertical, ocupacional y no ocupacional). [Prevention of HIV transmission (vertical, occupational and non-occupational)]. Enferm Infecc Microbiol Clin. 2011 Oct;29(8):615-25. Abstract
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