Breastfeeding in HIV-positive mothers under optimized conditions: ‘real-life’ results from a well-resourced healthcare setting

OBJECTIVES: Global guidelines increasingly support breastfeeding among women living with HIV (WLWH) under optimized conditions. However, outcome data from high-resource settings remain limited. METHODS: We retrospectively analyzed WLWH who delivered at Charité - Universitätsmedizin Berlin between 2017 and 2023. Eligibility for breastfeeding required VL<50 cop/mL. RESULTS: Of 409 WLWH, 365 (89.2 %) were eligible and 77 (18.8 %) initiated breastfeeding. No case of mother-to-child transmission (MTCT) was observed. Sustained viral suppression and ART adherence were key. Exclusive breastfeeding was associated with longer duration (p=0.001), midwifery care promoted exclusivity (p=0.009), and vaginal delivery was linked to longer duration (p=0.005). CONCLUSIONS: Breastfeeding with VL<50 cop/mL appears safe in high-resource settings. Findings support individualized counseling, close monitoring, and multidisciplinary care. The increasing breastfeeding trend reflects a shift in clinical practice.