HIV.gov visited with Dr. Laura Cheever during the 2023 Conference on Retroviruses and Opportunistic Infections (CROI) this week. Dr. Cheever is HRSA’s Associate Administrator for the HIV/AIDS Bureau and leads the Ryan White HIV/AIDS Program. She highlighted two presentations from the conference, one on the recently updated HIV clinical guidelines on infant feeding and the other on a study showing that injectable antiretroviral therapy (ART) can improve outcomes in underserved patients. Watch our conversationExit Disclaimer with Dr. Cheever below:

Updated Infant Feeding Guidelines

Dr. Cheever discussed a special presentation at CROI by Dr. Judy Levison of Baylor College of Medicine about the HHS HIV clinical practice guidelines updated in January 2023 to incorporate breastfeeding options for people with HIV who are on ART and have a sustained undetectable viral load. The updated guidelines support shared decision-making between people with HIV and their healthcare providers regarding infant feeding. The guidelines note that taking HIV medicine and keeping an undetectable viral load substantially decreases a person’s risk of transmitting HIV to their infant through breastfeeding/chestfeeding to less than 1%. However, the risk is not zero. Properly prepared infant formula or pasteurized donor human breastmilk from a milk bank are alternative options that eliminate the risk of transmission through breastfeeding. Clinicians should support the choices of people with HIV to breastfeed if they are virally suppressed or to formula/replacement feed. As Dr. Cheever emphasized, the guidelines further state that it is inappropriate to engage Child Protective Services (CPS) or similar services in response to the infant feeding choices of people with HIV. Due to the potential of HIV transmission in human milk, previous HHS HIV clinical guidelines did not recommend breastfeeding for individuals with HIV in the United States.

Study: Long-Acting Injectable ART May Improve Outcomes for Underserved Patients

Dr. Cheever also discussed a clinical study demonstrating that long-acting antiretroviral therapy (LA-ART) was effective in achieving and sustaining virologic suppression among people who were previously not virologically suppressed due to challenges taking a daily pill for HIV treatment. Dr. Monica Gandhi of the University of California San Francisco and the Ward 86 HIV clinic at San Francisco General Hospital presented the study, which engaged people with HIV who were experiencing housing insecurity, mental illness, and/or substance use disorder and provided them with both LA-ART and comprehensive support services. The support services, some of which were provided through the Ryan White HIV/AIDS Program, involved a team approach to help connect clients to food or other services needed. Dr. Cheever observed that this real-world study among a population that could potentially benefit most from LA-ART achieved the same viral suppression rates as the earlier clinical trials that formed the basis for FDA approval of the injectable LA-ART. Read more about the study here.

About CROI

CROI is an annual scientific meeting that brings together leading researchers and clinical investigators from around the world to present, discuss, and critique the latest studies that can help accelerate global progress in the response to HIV and AIDS and other infectious diseases, including viral hepatitis, COVID-19, and mpox. More than 3,400 HIV and infectious disease researchers from 72 countries gathered in Seattle and virtually this year for this forum. Over 900 scientific abstracts were being presented at CROI. Visit the conference websiteExit Disclaimer for more information; abstracts, session webcasts, and e-posters will be published there for public access in 30 days.

More HIV Research Updates to Follow on HIV.gov

HIV.gov is sharing additional video interviews from CROI 2023 with NIH’s Dr. Carl Dieffenbach as well as with CDC’s Dr. Jono Mermin and Dr. John Brooks. You can find them on HIV.gov’s social media channels and re-capped here on the blog. Be sure to watch, comment, and share!