Infant Feeding for Persons Living With and at Risk for HIV in the United States: Clinical Report

Area of Science:

• Pediatric Health
• Infectious Disease
• Public Health

Background:

• Infants born to people with HIV require specific feeding guidance.
• Healthcare providers must understand HIV transmission risks via breastfeeding.
• Current US recommendations balance risk reduction with family-centered care.

Purpose of the Study:

• To inform pediatric health professionals about infant feeding recommendations for infants with perinatal HIV exposure.
• To outline harm reduction strategies for parents with HIV who wish to breastfeed.
• To emphasize the importance of antiretroviral treatment (ART) and viral suppression.

Main Methods:

• Review of current guidelines from the American Academy of Pediatrics.
• Analysis of HIV transmission risks associated with breastfeeding.
• Discussion of harm reduction approaches in pediatric HIV care.

Main Results:

• Breastfeeding from a parent with HIV on ART and viral suppression has <1% transmission risk.
• The only 0% risk option is avoidance of breastfeeding for people with HIV in the US.
• Counseling should recommend against breastfeeding if ART is not used or viral suppression is not achieved.

Conclusions:

• Pediatricians should adopt a nonjudgmental, harm reduction approach for HIV-positive parents desiring to breastfeed on ART.
• HIV testing and pre-exposure prophylaxis (PrEP) are crucial for pregnant and breastfeeding individuals at high risk.
• Clear guidance is needed to support informed infant feeding decisions for families affected by HIV.