Maternal, newborn, child and adolescent health

HIV and infant feeding

A social health worker giving nutritional counselling to a HIV positive mother with two HIV positive kids.

Breastfeeding is normally the best way to feed an infant. A woman infected with HIV, however, can transmit the virus to her child during pregnancy, labour or delivery, or through breastfeeding. However, breastfeeding, and especially early and exclusive breastfeeding, is one of the most valuable interventions for improving child survival. Breastfeeding also confers many benefits in addition to reducing the risk of child mortality.

The dilemma has been to balance the risk of infants acquiring HIV through breastfeeding with the risk of death from causes other than HIV, in particular malnutrition and serious illnesses such as diarrhoea and pneumonia among non-breastfed infants. For these reasons, health workers in countries where both HIV is common and many children die from these other illnesses, have faced a real challenge in identifying and promoting the best feeding practice for infants in their care whose mothers are HIV-infected.

A large body of evidence on HIV and infant feeding has accumulated in recent years which shows that giving antiretroviral drugs (ARVs) to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV through breastfeeding.

In view of this evidence, in 2010 WHO released new guidelines on HIV and infant feeding containing revised principles and recommendations for infant feeding in the context of HIV and a summary of evidence that resulted in the guidelines. At the same time, new recommendations were released on antiretroviral therapy for infants and children, as well as for adults and adolescents, and for the prevention of mother-to-child transmission of HIV. Together, the recommendations provide simple, coherent and feasible guidance to countries for promoting and supporting improved infant feeding by HIV-infected mothers.