{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T19:18:07Z","timestamp":1793992687075,"version":"4.8.0"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Assoc Provid AIDS Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Breastfeeding in women living with HIV remains controversial despite effective antiretroviral therapy (ART), as a small residual transmission risk persists even with viral suppression, leading to divergent global recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a narrative review and policy analysis of randomized trials, international guidelines, and national recommendations (2010\u20132025), focusing on breastfeeding policies, maternal ART, infant prophylaxis, and monitoring strategies across settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Evidence from resource-limited settings shows maternal ART during breastfeeding reduces transmission and improves HIV-free survival, supporting WHO recommendations for breastfeeding with ART and infant prophylaxis. In high-income countries, breastfeeding is often discouraged due to safe alternatives, though some guidelines now allow it under strict viral suppression and close monitoring. Observational studies suggest transmission is rare when suppression is maintained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Differences in guidance mainly reflect risk tolerance and ethics rather than evidence. Breastfeeding may be considered a conditional option within structured clinical pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259582261471868","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:59:12Z","timestamp":1784642352000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Breastfeeding in Women Living With HIV in the ART Era: Toward Risk-Adapted Clinical Care"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6121-1659","authenticated-orcid":false,"given":"Akel","family":"Azzi","sequence":"first","affiliation":[{"name":"Saint Joseph University of Beirut"},{"name":"Saint-Joseph University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nassar","family":"El Assaad","sequence":"additional","affiliation":[{"name":"Saint-Joseph University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Haddad","sequence":"additional","affiliation":[{"name":"Saint-Joseph University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joe","family":"Lebbos","sequence":"additional","affiliation":[{"name":"Saint-Joseph University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Choucair","sequence":"additional","affiliation":[{"name":"Saint Joseph University of Beirut"},{"name":"Saint-Joseph University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"e_1_3_7_2_2","volume-title":"Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach","author":"World Health Organization","year":"2021","unstructured":"World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. World Health Organization; 2021. https:\/\/iris.who.int\/handle\/10665\/340190"},{"key":"e_1_3_7_3_2","volume-title":"Guideline: Updates on HIV and Infant Feeding: The Duration of Breastfeeding and Support From Health Services to Improve Feeding Practices Among Mothers Living With HIV","author":"World Health Organization, United Nations Children's Fund","year":"2016","unstructured":"World Health Organization, United Nations Children's Fund. Guideline: Updates on HIV and Infant Feeding: The Duration of Breastfeeding and Support From Health Services to Improve Feeding Practices Among Mothers Living With HIV. World Health Organization; 2016. https:\/\/www.who.int\/publications\/i\/item\/9789241549707"},{"key":"e_1_3_7_4_2","unstructured":"Centers for Disease Control and Prevention. HIV and breastfeeding. https:\/\/www.cdc.gov\/breastfeeding-special-circumstances\/hcp\/illnesses-conditions\/hiv.html"},{"key":"e_1_3_7_5_2","volume-title":"2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates","author":"National Department of Health (South Africa)","year":"2023","unstructured":"National Department of Health (South Africa). 2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates. National Department of Health; 2023."},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.18697\/ajfand.52"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001612"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(10)70288-7"},{"key":"e_1_3_7_9_2","volume-title":"Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States","author":"National Institutes of Health","year":"2026","unstructured":"National Institutes of Health. Preventing HIV transmission during infant feeding. 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