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Chestfeeding Toolkit

At UC San Diego, we believe in informed, patient-centered care for individuals living with HIV who are considering breast or chestfeeding. In alignment with updated national and global guidelines, we provide clinical support, counseling tools, and multidisciplinary coordination to ensure safe, supported infant feeding.

What's New?

  • CDC Guidelines (2023) now support shared decision-making around breastfeeding for people living with HIV.

  • UCSD Policy (2024) enables clinicians to offer care aligned with each patient’s informed choice.

  • A shift toward evidence-based, compassionate care means we no longer default to formula-only recommendations in the U.S.

For Patients

Can I Breastfeed While Living with HIV?

All parents should receive supportive counseling regarding their infant feeding choices, including breastfeeding. If the birthing parent is on antiretroviral therapy (ART), has an undetectable viral load, and works closely with a healthcare provider for follow-up, the risk of transmission of HIV to the newborn is <1%.

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What do the Guidelines say?

In the United States and Similar Settings:

  • Current Guidelines (CDC, DHHS):
    A birthing parent living with HIV can breastfeed but there is still a small risk of transmitting HIV through breast milk, even if you are on effective ART with an undetectable viral load.

  • Safe Alternatives:
    Infant formula is safe, affordable, and readily available in the U.S. Formula completely eliminates the risk of HIV transmission through feeding.

 

What If My Viral Load Is Undetectable?

  • U=U (Undetectable = Untransmittable) does not fully apply to breastfeeding.

  • Breastmilk transmission is different from sexual transmission; small risks remain, even if your viral load is undetectable.

 

Questions to Ask Your Provider:

  1. What do U.S. guidelines recommend for me?

  2. How does my specific health status affect the risks?

  3. Will I have access to supportive lactation services if I choose to breastfeed?

  4. If I were to breastfeed, what monitoring would be necessary for my baby and me?

  5. What type of prophylaxis would my baby take and for how long?

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For Providers

UC San Diego Health Policy Summary

Infant Feeding for Patients Living with HIV

UC San Diego Health supports informed, shared decision-making between patients and providers around infant feeding options for people living with HIV. This policy ensures care is safe, individualized, and aligned with the latest clinical evidence.

🧠 Informed, Shared Decision-Making

  • Providers engage in honest, respectful conversations about feeding options.

  • Counseling includes risks of HIV transmission, benefits of breastfeeding, and formula alternatives.

  • Final decisions are made collaboratively, respecting patient values and circumstances.

💊 Eligibility to Breast/Chestfeed

Patients are considered low risk for chestfeeding if the criteria below are met:

  • Consistent adherence to antiretroviral therapy (ART)

  • Sustained undetectable viral load throughout pregnancy and postpartum

  • Ongoing engagement in medical care and lab monitoring

👶 Infant HIV Testing & Monitoring

Infants must undergo expanded testing during and after breast/chestfeeding:

  • Scheduled blood tests throughout chestfeeding

  • Post-weaning follow-up testing as recommended

  • Close coordination with pediatric infectious disease specialists is recommended

📝 Documentation

Providers are recommended to document:

  • Patient’s understanding of HIV transmission risks

  • Shared decision-making process

  • Plans for ART adherence, infant testing, and follow-up care

  • Any patient concerns or changes in feeding intent

🩺 Breast/Chest Health Management

To reduce HIV transmission risk,  patients should be followed closely to manage chestfeeding complications:

  • Prompt evaluation and treatment of mastitis, abscesses, cracked nipples, or other complications

  • Temporary pausing or stopping breastfeeding if there is a concern of increased transmission

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Perinatal HIV Hotline – 1-888-448-8765

24/7 provider support line for perinatal HIV care guidance, including infant feeding.

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Guideline Links:

 

Archived Webinars:

 

Slides:

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