HIV/AIDS: Infant feeding and nutrition

WHO recommends that all mothers living with HIV should receive life-long antiretroviral therapy (ART) to support their health and to ensure the wellbeing of their infants.

WHO released guidelines in July 2016 advising that, in countries that have opted to promote and support breastfeeding together with ART, mothers living with HIV who are on ART and adherent to therapy should breastfeed exclusively for the first 6 months, and then add complementary feeding until 12 months of age. Breastfeeding with complementary feeding may continue until 24 months of age or beyond.

Previously, WHO advice was to breastfeed for 12 months but then stop breastfeeding if a nutritionally adequate and safe diet could be provided.

The new guidance is based on scientific evidence that shows ART is very effective at preventing HIV transmission through breastfeeding as long as the mother is adherent to therapy. The new evidence means that mothers living with HIV and their children can benefit from the many advantages of breastfeeding – such as improved growth and development – in the same way as mothers who do not have HIV and their children. WHO recommendations emphasise the need for health systems to therefore achieve quality HIV services that reliably provide ART and continue to care for mothers living with HIV.

Yes. Mothers living with HIV can be reassured that ART reduces the risk of post-natal HIV transmission even when the baby is on mixed feeding. Although exclusive breastfeeding is recommended for the first 6 months, mixed feeding is better than no breastfeeding. Encouraging mothers living with HIV to breastfeed exclusively is still strongly advised because it benefits the infant in many ways including, reduced illness, and improved growth and development.

Yes. Mothers and health-care workers can be reassured that shorter durations of breastfeeding of less than 12 months are better than never initiating breastfeeding.

Governments and local authorities should actively promote and implement services to create a supportive environment for mothers living with HIV to remain adherent to treatment and to breastfeed their infants in all settings: at work, at community centres, in health clinics, and in their homes.