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Breastfeeding Safely
Aug 7, 2011

My husband of nearly 2 years is HIV posiitive, although has had undetectable levels for some time now due to his HARRT treatment (Atripla). Last year we concieved a child and I've remained negative thus far. We have recently begun to resume our sex life and use harm reduction strategies to prevent me getting infected. We don't use condoms, normally the pull out method or mutual masterbation. My question is this: Our son is 10 weeks old and I am breastfeeding. With my husband being undetectable and our harm reduction sex life, what is your opinion of continuing to breastfeed for up to a year? My husband also has HepC...do I need to worry about that at all with regard to infection or passing that along to my newborn? Thanks Doctor.

Response from Dr. Frascino

Hello.

Responding to your direct questions:

1. If you are and remain HIV negative, there is no HIV-transmission risk in breastfeeding your newborn.

2. Hepatitis C is not transmitted via breastfeeding.

I must also address your safety and maintaining your HIV-negative status. That your husband is on Atripla and his viral load is undetectable significantly reduces HIV-transmission risk, but doesn't completely eliminate it.

The "pull out method" for penetrative sex still leaves you at considerable risk for acquiring HIV. HIV can be found in pre-cum (pre-ejaculate fluid). Consequently even pulling out for orgasm does not eliminate HIV-transmission risk. You report you don't use condoms? Why not? They are the most effective way to protect your HIV-negative status. I would very strongly advise you begin using them immediately for all penetrative sexual activity. You'll also need HIV-antibody testing at the three- and six-month marks from the date of last exposure (unprotected "pull-out" sex) to confirm you are HIV negative. You and your positively charged husband should read through the chapter in the archives of this forum devoted to magnetic couples. There are additional harm-reduction measures to consider, including having a starter pack of PEP (post-exposure prophylaxis) readily available in case of an accidental exposure (condom break, etc.). You could also consider PrEP (pre-exposure prophylaxis). Talk to your husband's HIV specialist about your options.

Good luck. Be well. Stay well.

Dr. Bob



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