Belgian guidance 2026 on management of pregnancy and breastfeeding in women living with HIV and their infants.

INTRODUCTION

In 2021, a call was made to write a guidance for the management of pregnancy in women living with HIV (WLWH) in Belgium.

METHODS

The call was sent to BREACH (Belgium Research on AIDS and HIV Consortium), a network of Belgian HIV Reference Centers, Laboratories and interest organizations in the field of HIV. The first working group (30 healthcare workers from 13 institutions) reviewed literature and had online discussions. This Guidance is an expert consensus document designed to answer real life clinical situations; it was presented at BREACH symposium in November 2023 and then updated annually.

RESULTS

Antiretroviral drugs prescribed to women considering pregnancy or during pregnancy are classified as 'recommended', 'not recommended', or 'insufficient data. If viral load (VL) at week 36 of pregnancy is ≤50 copies/ml, vaginal delivery without intrapartum zidovudine (IPZ) is recommended but if ≥1000 copies/ml, a scheduled caesarean section (SCS) and IPZ are indicated. In case of VL between 50 and 1000 copies/ml at week 36, IPZ should be given. If maternal VL is ≤50 copies/ml before and throughout pregnancy, antiretroviral prophylaxis for the newborn is not indicated. Benefits and potential risk of breastfeeding should be discussed with the future mother: fully suppressed maternal VL from conception to delivery is considered at very low risk of HIV transmission during breastfeeding. Maternal VL control every 6 weeks and close follow-up by a multidisciplinary team should be offered during exclusive breastfeeding of maximum 6 months to minimize risk of HIV transmission. Shared decision making with the future mother is advised for antiretroviral treatment preference, SCS if VL is between 50 and 1000 copies/ml and infant feeding choices.

CONCLUSION

The Belgian Guidance on management of pregnancy and breastfeeding in WLWH and their infant can be used as a reference for Belgian clinicians and is freely available online.