Nelson Textbook of Pediatrics 22nd Edition | Infant feeding counseling for HIV-exposed infants is complex. In resource-rich settings (U.S., Europe), formula feeding is recommended to eliminate HIV transmission (<1% risk with maternal viral suppression, but not zero). In resource-limited settings, exclusive breastfeeding with maternal/infant antiretroviral prophylaxis is recommended. Shared decision-making, frequent viral load monitoring, and infant HIV testing are essential. The risk of transmission via breast milk with suppressed maternal VL is <1% but not zero.
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