{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T06:45:45Z","timestamp":1782456345773,"version":"3.54.5"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Reprod. Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>United States national guidelines around infant feeding in the setting of maternal HIV were updated significantly in 2023. The updated guidelines encourage evidence-based counseling and emphasize shared decision-making around infant feeding, supplanting a blanket recommendation for replacement feeding. This scoping review seeks to capture the shift in clinical practices and perspectives of people living with HIV and their healthcare providers since 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Our review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews. We conducted a search of articles published in or after 2023 and focused on infant feeding guidelines in the setting of HIV or the infant feeding experiences of people living with HIV and providers that care for individuals with HIV in the peripartum and postpartum periods. We excluded studies that were not published in English. We searched MEDLINE, Embase, Cochrane's CENTRAL, CINAHL Ultimate, and Web of Science Core Collection and included all years from 2023 to the final date of search on January 6, 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our search yielded qualitative studies on both provider and patient experiences, protocols for implementation of the new guidelines, quantitative studies on HIV transmission in breastfeeding people living with HIV, and opinion pieces rooted in evidence. Our review found emergent safety data on breastfeeding among people living with HIV. Studies on provider experiences demonstrated variability in experience and comfort around breastfeeding, exacerbated by a lack of institutional guidelines on breastfeeding. Our review both highlighted evidence and expert opinion that counselling on infant feeding should be conducted by a multidisciplinary care team and tailored to the individual patient. Patient experiences highlighted that infant feeding decisions among people living with HIV are shaped by sociocultural contexts, personal motivations to breastfeed, patient knowledge on breastfeeding safety, and communication with their healthcare provider.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Recommendations to optimize counseling and care around infant feeding include an approach that is evidence-based, culturally sensitive, and free from bias. Areas for continued work include research on the optimal frequency of maternal and infant testing in the postpartum period and efforts to implement infant feeding guidelines in a clear and consistent manner across institutions and healthcare practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frph.2026.1864784","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:46:02Z","timestamp":1782452762000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Breastfeeding practices and perspectives in the setting of maternal HIV in high-income countries since the shift in the United States national guidelines: a scoping review"],"prefix":"10.3389","volume":"8","author":[{"given":"Naquia","family":"Unwala","sequence":"first","affiliation":[{"name":"Georgetown University School of Medicine","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Presley","family":"Simmons","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Scott","family":"Dorris","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel K.","family":"Scott","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine","place":["Washington, DC, United States"]},{"name":"The Women's and Children's Research Network, MedStar Health Research Institute","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"B1","year":""},{"key":"B2","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1177\/004947559002000108","article-title":"Do the benefits of breastfeeding outweigh the risk of postnatal transmission of HIV via breastmilk?","volume":"20","author":"Kennedy","year":"1990","journal-title":"Trop Doct"},{"key":"B3","year":""},{"key":"B4","first-page":"215","article-title":"Pregnancy in women living with HIV: experience of IRCCS san gerardo dei tintori and a narrative review","volume":"48","author":"Ranzani","year":"2025","journal-title":"New Microbiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e2025071516","DOI":"10.1542\/peds.2025-071516","article-title":"Breastfeeding and health outcomes for infants and children: a systematic review","volume":"156","author":"Patnode","year":"2025","journal-title":"Pediatrics"},{"key":"B6","doi-asserted-by":"publisher","first-page":"744104","DOI":"10.3389\/fped.2021.744104","article-title":"Breastfeeding contributes to physiological immune programming in the newborn","volume":"9","author":"Camacho-Morales","year":"2021","journal-title":"Front Pediatr"},{"key":"B7","year":"2025"},{"key":"B8","year":"2017"},{"key":"B9","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1097\/QAI.0000000000001612","article-title":"Prevention of HIV-1 transmission through breastfeeding: efficacy and safety of maternal antiretroviral therapy versus infant nevirapine prophylaxis for duration of breastfeeding in HIV-1-infected women with high CD4 cell count (IMPAACT PROMISE): a randomized, open label, clinical trial","volume":"77","author":"Flynn","year":"2018","journal-title":"J Acquir Immune Defic Syndr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e534","DOI":"10.1016\/S2352-3018(22)00173-4","article-title":"72 Weeks post-partum follow-up of dolutegravir versus efavirenz initiated in late pregnancy (DolPHIN-2): an open-label, randomised controlled study","volume":"9","author":"Malaba","year":"2022","journal-title":"Lancet HIV"},{"key":"B11","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1016\/j.idc.2024.06.005","article-title":"Advances in HIV management during pregnancy and infant feeding","volume":"38","author":"Espinal","year":"2024","journal-title":"Infect Clin N Am"},{"key":"B12","doi-asserted-by":"publisher","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann Intern Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1361","DOI":"10.1007\/s11606-012-2077-6","article-title":"Shared decision-making: a model for clinical practice","volume":"27","author":"Elwyn","year":"2012","journal-title":"J Gen Intern Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1515\/jpm-2025-0170","article-title":"Breastfeeding in HIV-positive mothers under optimized conditions: \u201creal-life\u201d results from a well-resourced healthcare setting","volume":"53","author":"Feiterna-Sperling","year":"2025","journal-title":"J Perinat Med"},{"key":"B15","first-page":"10","article-title":"Monitoring clinical practice of BHIVA-supported breastfeeding guidelines for women living with HIV in the UK","volume":"24","author":"Francis","year":"2023","journal-title":"HIV Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1093\/cid\/ciad235","article-title":"Breastfeeding among people with human immunodeficiency virus in North America: a multisite study","volume":"77","author":"Levison","year":"2023","journal-title":"Clin Infect Dis"},{"key":"B17","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1093\/jpids\/piae045","article-title":"From guidelines to practice: a programmatic model for implementation of the updated infant feeding recommendations for people living with HIV","volume":"13","author":"Boyce","year":"2024","journal-title":"J Pediatr Infect Soc"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1542\/peds.2024-066843","article-title":"Infant feeding for persons living with and at risk for HIV in the United States: clinical report","volume":"153","author":"Abuogi","year":"2024","journal-title":"J Pediatr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1093\/cid\/ciae027","article-title":"In support of breast-\/chestfeeding by people with HIV in high-income settings","volume":"79","author":"Powell","year":"2024","journal-title":"Clin Infect Dis"},{"key":"B20","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1097\/JNC.0000000000000585","article-title":"Association of nurses in AIDS care position on breastfeeding and chestfeeding: ensuring equity, autonomy, access, and respect in HIV-related infant feeding decisions","volume":"36","author":"Barr","year":"2025","journal-title":"J Assoc Nurses AIDS Care"},{"key":"B21","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1097\/QAI.0000000000003213","article-title":"Development and implementation of an interdisciplinary model for the management of breastfeeding in women with HIV in the United States: experience from the children\u2019s hospital Colorado immunodeficiency program","volume":"93","author":"Abuogi","year":"2023","journal-title":"J Acquir Immune Defic Syndr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"100509","DOI":"10.1016\/j.lana.2023.100509","article-title":"Infant feeding for people living with HIV in high resource settings: a multi-disciplinary approach with best practices to maximise risk reduction","volume":"22","author":"Powell","year":"2023","journal-title":"Lanc Reg Health Am"},{"key":"B23","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1093\/cid\/ciac761","article-title":"Providers have a responsibility to discuss options for infant feeding with pregnant people with human immunodeficiency virus in high-income countries","volume":"76","author":"McKinney","year":"2023","journal-title":"Clin Infect Dis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1007\/s11904-025-00745-0","article-title":"HIV And pregnancy: navigating complex decision-making and preventing perinatal transmission","volume":"22","author":"Short","year":"2025","journal-title":"Curr HIVAIDS Rep"},{"key":"B25","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1089\/apc.2022.0178","article-title":"Tilting the scale: current provider perspectives and practices on breastfeeding with HIV in the United States","volume":"37","author":"Lai","year":"2023","journal-title":"AIDS Patient Care STDs"},{"key":"B26","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1097\/GRF.0000000000000887","article-title":"Updates in the management of HIV during pregnancy","volume":"67","author":"Benson","year":"2024","journal-title":"Clin Obstet Gynecol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e531","DOI":"10.1016\/S2352-3018(18)30098-5","article-title":"Does U=U for breastfeeding mothers and infants? Breastfeeding by mothers on effective treatment for HIV infection in high-income settings","volume":"5","author":"Waitt","year":"2018","journal-title":"Lancet HIV"},{"key":"B28","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/joim.12986","article-title":"Women living with HIV in high-income settings and breastfeeding","volume":"287","author":"Moseholm","year":"2020","journal-title":"J Intern Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1111\/hiv.13583","article-title":"Guidelines and practice of breastfeeding in women living with HIV-results from the European INSURE survey","volume":"25","author":"Keane","year":"2024","journal-title":"HIV Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1111\/hiv.70072","article-title":"European Guidelines on HIV and breastfeeding: \u201csame, same, but different\u201d\u2014results from a WAVE survey","volume":"26","author":"Keane","year":"2025","journal-title":"HIV Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1111\/hiv.13723","article-title":"HIV Postnatal prophylaxis and infant feeding policies vary across Europe: results of a penta survey","volume":"26","author":"Fernandes","year":"2025","journal-title":"HIV Med"},{"key":"B32","author":"Alcorn","year":"2025"},{"key":"B33","doi-asserted-by":"publisher","first-page":"102551","DOI":"10.1016\/j.jogc.2024.102551","article-title":"Guideline no. 450: care of pregnant women living with HIV and interventions to reduce perinatal transmission","volume":"46","author":"Atkinson","year":"2024","journal-title":"J Obstet Gynaecol Can"},{"key":"B34","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.cnur.2023.12.004","article-title":"A review of updated guidelines on breastfeeding with human immunodeficiency virus using relational decision-making and intellectual humility to support infant feeding choices","volume":"59","author":"Barr","year":"2024","journal-title":"Nurs Clin N Am"},{"key":"B35","doi-asserted-by":"publisher","first-page":"4537","DOI":"10.57187\/s.4537","article-title":"Breastfeeding with HIV in a high-income setting: equipoise and beyond\u2014time to question the zero-risk policy","volume":"155","author":"Rudin","year":"2025","journal-title":"Swiss Med Wkly"},{"key":"B36","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/QCO.0000000000000986","article-title":"Infant feeding: emerging concepts to prevent HIV transmission","volume":"37","author":"Bamford","year":"2024","journal-title":"Curr Opin Infect Dis"},{"key":"B37","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1016\/j.clp.2024.08.002","article-title":"When black and white turns gray: navigating the ethical challenges of implementing shared infant feeding decisions for persons living with human immunodeficiency virus in the United States","volume":"51","author":"Nightingale","year":"2024","journal-title":"Clin Perinatol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1093\/jpids\/piae133","article-title":"Practice variability in uptake and implementation of new U.S. DHHS guidelines for feeding of HIV-exposed infants","volume":"14","author":"Rozen Eisenberg","year":"2025","journal-title":"J Pediatr Infect Soc"},{"key":"B39","doi-asserted-by":"publisher","first-page":"ofaf607","DOI":"10.1093\/ofid\/ofaf607","article-title":"Adoption of the revised DHHS guidelines on breastmilk feeding and HIV in the United States: clinical practices and barriers","volume":"12","author":"Ikeri","year":"2025","journal-title":"Open Forum Infect Dis"},{"key":"B40","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1089\/bfm.2024.0312","article-title":"Lactation support for breastfeeding and chestfeeding people with HIV: a call for research to examine telelactation experience, HIV knowledge, and lactation consultants\u2019 attitudes related to infant feeding with HIV","volume":"20","author":"Barr","year":"2025","journal-title":"Breastfeed Med"},{"key":"B41","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1080\/09540121.2025.2474666","article-title":"My body my baby\u201d: a qualitative study examining drivers of infant-feeding choices among women living with HIV in Philadelphia, United States","volume":"37","author":"Zapata Vaca","year":"2025","journal-title":"AIDS Care"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1852","DOI":"10.1080\/09540121.2022.2147481","article-title":"Attitudes on breast feeding among persons with HIV who have given birth and their perceptions of coercion during counseling on safe infant feeding practices","volume":"35","author":"Lazenby","year":"2023","journal-title":"AIDS Care"},{"key":"B43","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s13006-024-00677-2","article-title":"Infant feeding knowledge among women living with HIV and their interaction with healthcare providers in a high-income setting: a longitudinal mixed methods study","volume":"19","author":"Moseholm","year":"2024","journal-title":"Int Breastfeed J"},{"key":"B44","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.ejogrb.2023.02.013","article-title":"Successful implementation of new Swiss recommendations on breastfeeding of infants born to women living with HIV","volume":"283","author":"Crisinel","year":"2023","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"2130","DOI":"10.1186\/s12889-024-19581-9","article-title":"How women living with HIV in the UK manage infant-feeding decisions and vertical transmission risk\u2014a qualitative study","volume":"24","author":"Kasadha","year":"2024","journal-title":"BMC Public Health"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1007\/s10461-023-04142-9","article-title":"The mental health effects and experiences of breastfeeding decision-making among postpartum women living with HIV","volume":"28","author":"Harris","year":"2024","journal-title":"AIDS Behav"},{"key":"B47","doi-asserted-by":"publisher","first-page":"23259582251396636","DOI":"10.1177\/23259582251396636","article-title":"Opportunities and constraints to equitable implementation of the revised infant feeding guidelines for pregnant and lactating persons living with HIV in the United States: a qualitative study","volume":"24","author":"Buckland","year":"2025","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"B48","doi-asserted-by":"publisher","first-page":"2357871","DOI":"10.1080\/25787489.2024.2357871","article-title":"Parenting with HIV: a patient\u2019s view on updated infant feeding guidelines in the US","volume":"25","author":"Covin","year":"2024","journal-title":"HIV Res Clin Pr"},{"key":"B49","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1080\/09540121.2025.2562239","article-title":"Exploring the complexities of infant feeding decisions for immigrant pregnant people living with HIV in Ontario, Canada: a qualitative study","volume":"38","author":"John","year":"2026","journal-title":"AIDS Care"},{"key":"B50","doi-asserted-by":"publisher","first-page":"e0303788","DOI":"10.1371\/journal.pone.0303788","article-title":"Breastfeeding in women with HIV infection: a qualitative study of barriers and facilitators","volume":"19","author":"Chaparro","year":"2024","journal-title":"PLoS One Electron Resour"},{"key":"B51","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1097\/JNC.0000000000000411","article-title":"Go with the flow\u201d: a qualitative description of infant feeding experiences among women with HIV in the United States","volume":"34","author":"Pagano-Therrien","year":"2023","journal-title":"J Assoc Nurses AIDS Care"},{"key":"B52","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1089\/bfm.2023.0004","article-title":"Exploring the breastfeeding desires and decision-making of women living with HIV in The Netherlands: implications for perinatal HIV management in developed countries","volume":"18","author":"Bukkems","year":"2023","journal-title":"Breastfeed Med"},{"key":"B53","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12884-023-06198-w","article-title":"We decided together\u201d: a qualitative study about women with HIV navigating infant-feeding decisions with the father of their children","volume":"24","author":"Kasadha","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"B54","doi-asserted-by":"publisher","first-page":"e13871","DOI":"10.1111\/1467-9566.13871","article-title":"Hearing the silence and silenced: co-producing research on infant-feeding experiences and practices with black women with HIV","volume":"47","author":"Kasadha","year":"2025","journal-title":"Sociol Health Illn"}],"container-title":["Frontiers in Reproductive Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2026.1864784\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:46:03Z","timestamp":1782452763000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2026.1864784\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":54,"alternative-id":["10.3389\/frph.2026.1864784"],"URL":"https:\/\/doi.org\/10.3389\/frph.2026.1864784","relation":{},"ISSN":["2673-3153"],"issn-type":[{"value":"2673-3153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]},"article-number":"1864784"}}