In the UK, breast-feeding is universally considered as a potentially major route of transmission for HIV and is completely contraindicated,1 although guidelines are under constant review.2,3 Up to 20% of babies are born HIV-negative but subsequently acquire the infection through breast milk; however this proportion is still too high for breast-feeding to be considered safe. The presence of HIV in breast milk is not the only concern: blood from cracked nipples or capillary rupture are other possible transmission paths.
Therefore, in the UK, Hospital Trust guidelines unequivocally recommend that HIV-positive mothers must not breast-feed; child welfare services should be contacted if a HIV-positive woman is adamant about breast-feeding.
Evidence is emerging that antiretroviral therapy may reduce a number of breast milk-related transmissions in the developing world.4 However, the issues in regions of sub-Saharan Africa, where there are high rates of HIV infection and limited access to safe alternatives to breast milk4 are very different. Consequently it is inappropriate to apply these study findings to babies in the UK. Specialist advice, counselling and proper medical care is of the utmost importance if any HIV-positive woman in the UK is considering breast-feeding her baby; she must be strongly advised against doing so.

References1. Volmink J, Marais B. HIV: mother-to-child transmission. Clin Evid (Online) 2008; Feb 5; 2008. pii: 0909.

2. World Health Organization

3. La Leche League International.,   For current recommendations:

4. Kesho Bora study group. Maternal ART during pregnancy and breastfeeding prevents more infections than short-course prophylaxis. Available at. Accessed 12 Nov 2009.

From: Journal of Family Health Care Bulletin. Directory of Breast-Feeding Advice. December 2009. Published with JFHC 2009; 19(6).