This article describes ARV approaches to, and outcomes among, ten infants who were exclusively breastfed by nine mothers living with HIV and receiving care at a single U.S. urban health center. The center offered a multi-disciplinary support program to assist women with HIV who desired to breastfeed and met pre-established criteria (namely, adherence to care and ART, and sustained virologic suppression). Reasons for choosing to breastfeed included: concerns for infant health, disclosure concerns, cultural expectations, and religious beliefs. Eight women were non-native immigrants from low/middle-income countries in Africa, and four had previously delivered and nursed infants while living with HIV. Infants were initiated on a combination of zidovudine, lamivudine, and nevirapine for 4-6 weeks, followed by NVP alone continued through 6 weeks after breastfeeding discontinuation; mean duration of breastfeeding: 4.4 months. Mother-infant dyads were seen at monthly visits during which breastfeeding and ART adherence were assessed and supported, HIV PCR testing was pursued, and further counseling was provided e.g., guidance for weaning. Infant HIV RNA was measured at 2-8 week intervals (depending on age, breastfeeding status, timing relative to NVP/breastfeeding cessation). All infant had negative viral RNA PCR measurements at a median age of 16 months.