Multi-disciplinary support of infant feeding choice for parents living with HIV: experience across a guideline change

Support for infant feeding choice for people living with HIV (PLWH) in the United States has changed, with national guidelines encouraging collaborative decision making to support infant feeding decisions in 2023. In 2020, our institution developed a multi-disciplinary approach supporting patient-centered infant feeding counseling. Our study's objective was to describe the outcomes and experiences of parents engaging with this model.

Electronic records were reviewed for PLWH initiating Obstetric care between January 2020 and September 2025 in a maternal HIV program in Houston, Texas. Information regarding demographics, HIV care, participation in infant feeding support model, and feeding experiences was collected. Data was summarized using descriptive statistics.

336 PLWH initiated care during the study period. 75 considered breastfeeding, 51 completed Pediatric Retrovirology consultation to discuss benefits/risks, and 37 breastfed. No HIV transmissions occurred with breastfeeding. Of the 37 parents who breastfed, 92% maintained undetectable viral loads throughout breastfeeding. Median duration of breastfeeding was 47 days. 69% of these parents reported challenges with breastfeeding contributing to premature weaning. Post-delivery retention in HIV care was a significant challenge for parents (only 38% attended two of their own HIV care visits within 1 year), compared to neonates attending 84%-92% of Pediatric Retrovirology appointments for routine postnatal monitoring.

Our institution observed increasing interest in breastfeeding for PLWH, especially since the update of US guidelines. Half of our cohort who expressed interest ultimately breastfeed, but significant challenges remain limiting duration of breastfeeding and retention in postpartum HIV care.