European Guidelines on HIV and breastfeeding: "Same, same, but different" - Results from a WAVE survey

A notable gap exists in research on HIV and breastfeeding in high-income settings with continuous access to antiretroviral therapy (ART) and suppressed HIV viral loads. The Women Against Viruses in Europe (WAVE) initiative aimed to consolidate European guidelines on HIV and breastfeeding to better inform medical staff and people living with HIV in the decision-making process for breastfeeding.

Representatives from 23 countries were contacted by WAVE to submit their guidelines on HIV and breastfeeding, translated into English. The initial contact was made on 20 April 2023, and the final response was received on 26 May 2023. The WAVE breastfeeding group summarized the guidelines into key topics related to breastfeeding for the purpose of this manuscript.

A total of 19 guidelines from 20 countries were included in the review. While the majority of countries recommend formula feeding as the preferred feeding for infants born to mothers living with HIV, most provide recommendations to support parents who choose to breastfeed if certain criteria are met.

Despite recommendations being based on the same research, there is variation across guidelines. This review consolidates European guidelines, enabling us to learn from each other and pool our experiences to create a robust cohort for further research and guideline development for parents living with HIV and their infants.