Breastfeeding with HIV in a high-income setting: time to question the zero-risk policy
In a review article published in the Swiss Medical Weekly, Rudin et al. discussed whether breastfeeding should be actively encouraged among women living with HIV who maintain sustained viral suppression with combined antiretroviral therapy (cART).
The authors reviewed evidence from international studies showing that HIV transmission during breastfeeding is extremely rare under optimal conditions, including undetectable maternal viral load, reliable treatment adherence, and close follow-up. Notably, no confirmed cases of breastfeeding-associated HIV transmission have been reported in high-income countries with well-established healthcare systems under these conditions.
The review also highlights the well-established health benefits of breastfeeding for both infants and mothers, including reduced infant infections and lower maternal risks of breast cancer and diabetes. The authors argue that maintaining a strict “zero-risk” policy may contribute to HIV-related stigma and unnecessarily place responsibility on mothers.
The authors conclude that the benefits of breastfeeding likely outweigh the theoretical residual transmission risks in women with sustained viral suppression, and that breastfeeding should be supported and potentially encouraged in high-income settings.