Should women with HIV-1 infection breastfeed their infants? It depends on the setting.

Abstract

Breastfeeding is the ideal infant food—it provides both optimal nutrition and numerous factors that contribute to infant immunity, growth, cognition, and health. It also enhances maternal–infant bonding and child-spacing and may provide long-term benefits to mothers. An estimated 7.7 million children under 5 years of age die annually, with >30% dying of infectious diseases [1, 2]. Breastfeeding has been identified as the most effective intervention to prevent under-5 mortality [3]. It was therefore a huge public health and policy challenge to discern the best infant feeding strategy when it was discovered that HIV-1 could be transmitted through breastfeeding. While nonbreastfeeding could entirely prevent transmission of a rapidly fatal infection, implementation of artificial feeding could be associated with increased infant mortality and morbidity. Over the past two decades, mothers, clinicians, and policy makers have wrestled with balancing infant risk of HIV-1 acquisition against risk of infant mortality in the context of concurrently changing interventions that decrease transmission of HIV-1.