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.

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.