WHO and UNICEF update guideline on HIV and Infant feeding

The World Health Organization (WHO) and United Nations Children’s Emergency Fund (UNICEF) have updated the guideline on HIV and Infant feeding.

Background Information:

Glossary of Terms

Antiretroviral (ARV) drug: the medicine used to treat HIV infection.

Antiretroviral therapy (ART): the use of a combination of three or more ARV drugs for treating HIV infection. ART involves lifelong treatment.

Exclusive breastfeeding: the infant receives only breast milk without any other liquids or solids, not even water, except for oral rehydration solution or drops or syrups of vitamins, minerals or medicines.

Mixed feeding: an infant younger than six months of age is given other liquids and/or foods together with breast milk. This could be water, other types of milk or any type of solid food.

Replacement feeding: feeding an infant who is not receiving any breast milk with a diet that provides all the nutrients children need until they can be fully fed on family foods. During the first six months, this should be with a suitable breast milk substitute: commercial infant formula milk. After six months, it should preferably be with a suitable breast milk substitute and complementary foods made from appropriately prepared and nutrient enriched family foods given three to five times per day

WHO-recommended breastfeeding is defined as:

(1) initiation of breastfeeding within the first hour of life;

(2) exclusive breastfeeding for the first six months of life (that is, the infant only receives breast milk without any additional food or drink, not even water); followed by

(3) continued breastfeeding for up to two years of age or beyond (with the introduction of appropriate complementary foods at six months); and

(4) breastfeeding on demand – that is, as often as the child wants, day and night.

Safe replacement feeding

Mothers known to be living with HIV should only give commercial infant formula milk as a replacement feed to their HIV-uninfected infants or infants who are of unknown HIV status when specific conditions are met:

a. safe water and sanitation are assured at the household level and in the community; and

b. the mother or other caregiver can reliably provide sufficient infant formula milk to support the normal growth and development of the infant; and

c. the mother or caregiver can prepare it cleanly and frequently enough so that it is safe and carries a low risk of diarrhoea and malnutrition; and

d. the mother or caregiver can, in the first six months, exclusively give infant formula milk; and

e. the family supports this practice; and

f. the mother or caregiver can access health care that offers comprehensive child health services.

These descriptions are intended to give simpler and more explicit meaning to the concepts represented by AFASS (acceptable, feasible, affordable, sustainable and safe).

Key Messages:

1. Mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or longer (similar to the general population) while being fully supported for ART adherence.

“Mothers known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status) should exclusively breastfeed their infants for the first six months of life, introducing appropriate complementary foods thereafter and continue breastfeeding.”

“Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided.”

2. National and local health authorities should actively coordinate and implement services in health facilities and activities in workplaces, communities and homes to protect, promote and support breastfeeding among women living with HIV.

3. If a mother living with HIV does not exclusively breastfeed, is mixed feeding with ART better than no breastfeeding at all?

Mothers living with HIV and health-care workers can be reassured that ART reduces the risk of postnatal HIV transmission in the context of mixed feeding. Although exclusive breastfeeding is recommended, practising mixed feeding is not a reason to stop breastfeeding in the presence of ARV drugs.

4. If a mother living with HIV plans to return to work or school, is a shorter duration of planned breastfeeding with ART better than no breastfeeding at all?

Mothers living with HIV and health-care workers can be reassured that shorter durations of breastfeeding of less than 12 months are better than never initiating breastfeeding at all.

5. Mothers known to be living with HIV who decide to stop breastfeeding at any time should stop gradually within one month. Mothers or infants who have been receiving ARV drug prophylaxis should continue prophylaxis for one week after breastfeeding is fully stopped*. Stopping breastfeeding abruptly is not advisable.

*Remains valid. Nevertheless, lifelong ART is recommended now instead of ARV drug prophylaxis.

Note: The other guidelines remain unchanged from the previous (2010) recommendations.

Useful Links:

Link to the updated guideline document:


Link to WHO Questions and Answers page on HIV and infant feeding:


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