Breastfeeding on PrEP: What You Need to Know

Breastfeeding on PrEP: Safety and Benefits for Maternal Health

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During August, National Breastfeeding Month, we highlight the importance and benefits of breastfeeding/chestfeeding. At SisterLove, we aim to provide empowering information and support to help you make informed decisions about your sexual and reproductive health.

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PrEP: A Key HIV Prevention Strategy

Pre-exposure prophylaxis (PrEP) is a highly effective medication for preventing HIV. According to the CDC, PrEP reduces the risk of contracting HIV by about 99% through sexual contact and by at least 74% among people who inject drugs. Research indicates that PrEP is a safe and effective HIV prevention strategy for pregnant and breastfeeding people reducing the risk of HIV transmission to the baby. 

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PrEP and Breastfeeding 

The CDC recommends PrEP for HIV-negative adults and adolescents at risk of contracting HIV through sex or injection drug use. PrEP may be beneficial for individuals who have had recent anal or vaginal sex, have a sexual partner with HIV, don't consistently use condoms, have been diagnosed with an STI in the past six months, share needles, are attempting to conceive with an HIV-positive partner, or have used post-exposure prophylaxis (PEP) multiple times or continue to engage in risky behaviors. It is recommended that pregnant and breastfeeding persons with negative HIV test results who have sexual partners who have HIV or who are not virally suppressed on Antiretroviral therapy (ART) should have frequent HIV testing (eg, every 3 months throughout the breastfeeding period). In addition, when taking oral PrEP it is important to visit your provider or community health clinic every 3 months for follow-up visits, HIV tests, kidney function screenings and prescription refills. 

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Data shows that tenofovir was not detected in 94% of infant plasma samples meaning there is minimal infant drug exposure to PrEP through breast milk(Mugwanya et al. 2016). As PrEP passes through breast milk in very small amounts it is unlikely to cause any side effects that impact your baby and their health. However, some babies have had mild diarrhea that ​​resolved in 2–3 days. Consult with your provider, midwife, or lactation consultant if you have concerns about your child not feeding or having an upset stomach.     

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Conclusion

Breastfeeding while on PrEP is a viable option for many, offering protection against HIV while ensuring the numerous benefits of breastfeeding for both the parent and the child. It is essential to maintain regular healthcare visits and follow recommended guidelines to maximize safety and health outcomes. At SisterLove, we are committed to supporting you with the information and resources you need to make informed decisions about your reproductive health. Celebrate World Breastfeeding Month with us by embracing knowledge and empowerment in your breastfeeding journey.

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Schedule an appointment now at our historic Atlanta MotherHouse where we now offer PrEP! 

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Can't Make It To Us? No Problem! Request one of our free and easy-to-use home HIV self-test kits delivered discreetly to your door. Our certified experts will support you remotely, step-by-step.

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References

1. “Breastfeeding Benefits Both Baby and Mom.” Breastfeeding, 14 Dec. 2023, www.cdc.gov/breastfeeding/features/breastfeeding-benefits.html#:~:text=Mother's%20Health,first%20six%20months%20is%20recommended.
2. “Preventing HIV With PrEP.” HIV, 18 Jan. 2024, www.cdc.gov/hiv/prevention/prep.html#:~:text=Overview,to%20your%20health%20care%20provider.
3. Abuogi, Lisa, et al. “Infant Feeding for Persons Living With and at Risk for HIV in the United States: Clinical Report.” PEDIATRICS, vol. 153, no. 6, May 2024, https://doi.org/10.1542/peds.2024-066843.
4. US Public Health Service and Centers for Disease Control and Prevention. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2021 Update Clinical Practice Guideline. 2021, pp. 1–108. www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf.
5. Mugwanya, Kenneth K., et al. “Pre-exposure Prophylaxis Use by Breastfeeding HIV-Uninfected Women: A Prospective Short-Term Study of Antiretroviral Excretion in Breast Milk and Infant Absorption.” PLoS Medicine, vol. 13, no. 9, Sept. 2016, p. e1002132. https://doi.org/10.1371/journal.pmed.1002132.
6. Website, Nhs. “Pregnancy, Breastfeeding and Fertility While Taking Pre-Exposure Prophylaxis (PrEP).” nhs.uk, 13 Mar. 2023, www.nhs.uk/medicines/pre-exposure-prophylaxis-prep/pregnancy-breastfeeding-and-fertility-while-taking-pre-exposure-prophylaxis-prep/#:~:text=PrEP%20passes%20into%20breast%20milk,discuss%20the%20options%20with%20you.

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