The optimal infant feeding decision for HIV-infected mothers living in resource-constrained settings remains a major challenge in preventing mother-to-child transmission of HIV. HIV-infected mothers who breastfeed their babies risk transmitting the virus to their babies through breastmilk. However, replacement feeding (with infant formula) often poses risks of illness and death from malnutrition, pneumonia, and diarrheal diseases due to contaminated water.

The 2010 WHO guidelines emphasize that breastfeeding is a strategy for maximizing infant HIV-free survival. Thus, in an effort to balance the risks of mother-to-child transmission with the risks of increased morbidity and mortality associated with replacement feeding, two main revisions in the new guidelines on safe infant and young child feeding in the context of HIV are as follows:

1. HIV-infected mothers who choose to breastfeed should practice exclusive breastfeeding for the first six months of life. At 6 months, HIV-infected mothers should continue breastfeeding, while giving appropriate complementary foods, until at least 12 months of age.
2. Recommendations for safe infant feeding in the context of HIV should be made at the national or subnational level. Specifically, national or subnational authorities should decide whether health services should principally counsel HIV-infected mothers to either: Breastfeed and receive ARVs  or Avoid all breastfeeding and formula feed instead. The selected strategy should be the one that will most likely give infants the greatest chance of HIV-free survival, taking into consideration international recommendations, local economic conditions, cultural norms, availability and quality of health care services, and the local epidemiology including HIV prevalence and causes of infant and child mortality.

For more information on the 2010 WHO guidelines on safe infant and young child feeding in the context of HIV, see the full guidelines and related resources.