HIV-1 and Breastfeeding in the United States

While breastfeeding remains a significant source of mother-to-child HIV transmission (MTCT) globally, it is the recommended infant feeding option for HIV-infected women in resource-limited settings [1]. However, HIV-infected women in the USA—where breast milk alternatives are acceptable, feasible, affordable, sustainable, and safe—have been counseled to avoid all breastfeeding since 1985 [2]. A number of studies have found that despite such recommendations against breastfeeding by HIV-infected women, a very small proportion of HIV-infected women in the USA continue to breastfeed their infants [3–5] for various reasons. Many of these women received late or no prenatal care, inadequate antiretroviral (ARV) prophylaxis, or were not diagnosed with HIV until at or after labor and delivery. While breastfeeding has never been a major source of perinatal HIV infections in the USA, studies have identified the practice as a risk factor for MTCT in the USA [4]. Complete avoidance remains the only sure way to prevent late postnatal HIV transmission through breastfeeding.