Risk of Breastfeeding With HIV and Other Infections

Preventing Transmission in Newborns and Infants

In many parts of the world, breastfeeding is the only (and some might say) best source of nutrition for newborns and babies. Under normal circumstances, breastfeeding wouldn't be a concern. But in women with HIV, it can significantly increase the risk of transmission to your baby.

Rates of hepatitis B, hepatitis C, and herpes simplex virus (HSV) also run high in women with HIV. Do any of these pose a risk of infection if the mother decides to breastfeed?

Baby nursing
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Breastfeeding and HIV

While the rates of mother-to-child transmission have dropped dramatically in the United States, around a third of all HIV-positive children in the developing world have been infected through breastfeeding.

The risk of transmission is linked to a number of factors, more predominately the amount of virus in the mother's body (known as the viral load). By placing the mother on HIV therapy, you can suppress the virus to undetectable levels. With next to no virus in body fluids, including breast milk, the likelihood of transmission is dramatically decreased.

This is not to suggest that the risk of transmission is zero. Cracked or bleeding nipples can also potentiate infection through direct blood exposure.

In the U.S. and most developed countries, breastfeeding is not recommended for mothers with HIV. Rather, bottle feeding is advised whether there is an undetectable viral load or not.

Cost alone makes bottle-feeding impractical in resource-poor countries. As a result, most international guidelines suggest that mothers either exclusive breastfeed or exclusive bottle-feed. Mixed breast/bottle feeding (also known as supplemental feeding) should be avoided as it can increase the risk of transmission by as much as 45 percent, according to a report from the World Health Organization.

Breastfeeding and Hepatitis

Hepatitis B infection is of global concern with over 350 million infections worldwide While an estimated five percent of mothers are chronically infected, there is no evidence that breastfeeding poses any risk to nursing infants.

By contrast, hepatitis C can be passed from mother to child, particularly if the mother is co-infected with HIV. However, this most frequently occurs in the womb or, less commonly, during the delivery itself.

By contrast, the risk of hepatitis C infection through breastfeeding is considered negligible to nil. To date, no documented case has ever been reported. Experts do, however, advise women with cracked or bleeding nipples to avoid breastfeeding until the skin is fully healed.

Breastfeeding and Herpes Simplex Virus

Herpes simplex virus (HSV) is transmitted primarily through contact with an open sore or lesion. While HSV cannot be transmitted through breast milk, contact with sores on the nipples poses a serious risk to a newborn.

In such instances, mothers are advised bottle-feed their babies or use a breast pump so long as the equipment does not come into contact with a sore. Breastfeeding can be restarted once the sores are fully healed.

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  • Department of Health and Human Services. "Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States." Rockville, Maryland. Update issued May 21, 2013.
  • Peña, K.; Adelson, M.; Mordechai, E.; et al. "Genital Herpes Simplex Virus Type 1 in Women: Detection in Cervicovaginal Specimens from Gynecological Practices in the United States." Journal of Clinical Microbiology.January 2010; 48(1):150-153. DOI: 10.1128/JCM.01336-09.
  • World Health Organization (WHO). "Breast is always best - even for HIV-positive mothers." Bulletin of the World Health Organization. 2010; 88(1):1-80.

By Mark Cichocki, RN
Mark Cichocki, RN, is an HIV/AIDS nurse educator at the University of Michigan Health System for more than 20 years.