GUIDELINECanadian Pediatric Perinatal HIV/AIDS Research Group consensusrecommendations for infant feeding in the HIV contextSarah Khan MD,MSc',Kara KTsang PhD2,Jason Brophy MD,MSc3,Fatima Kakkar MD,MPH4,V LoganKennedy RN5,Isabelle Boucoiran MD,MSc5,Mark H Yudin MD,MSc7,Deborah Money MD,FRCSC,StanleyRead MD,MSC,PhD9,Ari Bitnun MD,MSc0 for the Canadian Pediatric Perinatal HM/AIDS Research Group,the Infectious Disease Committee of the Society of Obstetricians and Gynaecologists of Canada,theCanadian HIV and Viral Hepatitis Pharmacists Network,and the Association of Medical Microbiology andInfectious Disease CanadaBACKGROUND:Providing comprehensive infant feeding guidance to families affected by HIVis complex and requires a multidisci-plinary approach.While exclusive formula feeding remains the preferred recommendation for infants bom to women living withHIV (WLWH)in high-income countries,a more nuanced approach that may include the option of breastfeeding under certain cir-cumstances is emerging in many resource-rich countries.METHODS:The Canadian Pediatric Perinatal HIV/AIDS Research Group(CPARG)hosted a Canadian Institute of Health Research-funded meeting in 2016 to develop consensus among multidisciplinaryproviders around counselling and recommendations for infant feeding.After presentations by adult and paediatric health careproviders,basic scientists,and community-based researchers,a subgroup drafted summary evidence-informed recommendations.Along with revisions among CPARG members,a community review was performed by a convenience sample of WLWH who hadgiven birth in the past 5 years from Ontario and Quebec.A legal review was also conducted to ensure understanding of the crimin-alization potential and concern of HIV transmission and exposure.RESULTS:The Canadian consensus guidelines continue to sup-port formula feeding as the preferred method of infant feeding as it eliminates any residual risk of postnatal vertical transmission.Formula should be made available for all infants born to mothers living with HlVfor their first year of life.A comprehensive approachto counselling WLWH is outlined to assist providers to effectively counsel on current evidence to ensure WLWH are fully informed intheir decision making.For women meeting criteria to and elect to breastfeed,frequent matemal virologic monitoring and follow-upis required of both mother and infant.Antiretroviral prophylaxis and monitoring are recommended for breastfed infants.The com-munity review highlighted the importance of other supports and counselling needed for implementing effective formula feeding,aside from access to formula.The legal review provided clarifying language around child protection services involvement and theneed to provide referral to legal resources or information upon request.Surveillance systems to monitor for cases of breastmilktransmission should be in place to improve gaps in care and develop further knowledge in this area.CONCLUSION:The Canadianinfant feeding co
