Is breastfeeding with hepatitis C safe?

What does the evidence say about breastfeeding with hepatitis C while breastfeeding?

1. CDC states that mothers with hepatitis C can breastfeed and that there is no documented evidence of HCV transmission through breastfeeding. This guidance applies to HCV itself and does not settle questions about active nipple bleeding, HIV coinfection, or a specific medicine. 1
2. Because HCV is blood-borne and evidence during active nipple bleeding is insufficient, CDC advises temporarily stopping direct nursing when the nipple or areola is cracked and bleeding, expressing and discarding milk until the tissue is no longer bleeding, then resuming. 2
3. CDC recommends an HCV RNA nucleic acid test at age 2 to 6 months for all perinatally exposed infants. A detectable result needs pediatric hepatitis C expertise, while an undetectable result at or after two months needs no further follow-up unless clinically warranted. 3
4. HIV coinfection requires its own current infant-feeding counseling because HIV can pass through milk. CDC describes a less than 1% but nonzero breastfeeding transmission risk when antiretroviral therapy maintains a sustained undetectable viral load and calls for patient-centered shared decision-making and close follow-up. 4
5. LactMed's 2026 sofosbuvir review reports low measured milk levels in four postpartum users and says sofosbuvir alone or in listed combinations is not a reason to discontinue breastfeeding. Data remain limited, and this finding cannot be generalized to every hepatitis C regimen, especially ribavirin-containing combinations. 5

How breastfeeding with hepatitis C changes by nursing stage

• Early weeks. inspect nipples and areolas for active cracks or bleeding, especially while latch is developing. If blood is present, pause milk from the affected breast, remove and discard it to maintain supply, use an alternative feeding plan, and obtain prompt lactation help.
• Established nursing. hepatitis C alone is not a reason to wean. Keep maternal liver follow-up and the infant's HCV testing plan on schedule. Any HIV coinfection or direct-acting antiviral regimen changes the counseling and should be reviewed by the infectious-disease and pediatric teams.
• Weaning. Later lactation or weaning: breastfeeding duration does not replace infant HCV testing. CDC recommends an HCV RNA nucleic acid test at age 2 to 6 months for every perinatally exposed infant, with specialist consultation if HCV RNA is detectable.