Clinical Scorecard: Implementation of Updated DHHS Guidelines on Breastfeeding and HIV in the U.S.: Clinical Practices and Challenges
At a Glance
Category
Detail
Condition
Perinatal HIV exposure and infant feeding
Key Mechanisms
Risk of mother-to-child HIV transmission mitigated by effective ART and viral suppression; breastfeeding benefits include immune protection and maternal-infant bonding
Target Population
Infants born to individuals living with HIV in the United States
Care Setting
Neonatology and pediatric infectious diseases clinical settings in the US, including academic and nonacademic centers
Key Highlights
Updated 2023 DHHS guidelines recommend patient-centered counseling and shared decision-making for infant feeding in HIV.
Significant variability exists in clinical adoption of breastfeeding support among neonatologists and PID specialists.
Concerns about HIV transmission remain the primary barrier to breastfeeding support despite evidence of low transmission risk with viral suppression.
Guideline-Based Recommendations
Diagnosis
Assess HIV status and viral suppression in parents living with HIV prior to infant feeding decisions.
Management
Offer breastmilk feeding as an option for infants of virally suppressed parents with HIV.
Implement patient-centered counseling and shared decision-making regarding infant feeding choices.
Monitoring & Follow-up
Monitor viral suppression status of the parent living with HIV during breastfeeding period.
Risks
Recognize and address concerns about potential mother-to-child HIV transmission during breastfeeding.
Consider institutional variability and lack of standardized feeding guidelines as barriers.
Patient & Prescribing Data
Infants born to parents living with HIV in the US
Breastfeeding is underutilized due to provider concerns despite evidence supporting low transmission risk with effective ART and viral suppression.
Clinical Best Practices
Promote education and interventions targeting provider concerns about lactational HIV transmission.
Encourage development and adoption of institutional guidelines supporting breastfeeding in virally suppressed parents with HIV.
Support multidisciplinary collaboration between neonatologists and pediatric infectious diseases specialists to harmonize feeding practices.
