Clinical management of pregnancy, delivery and breastfeeding in women living with HIV in Italy: A survey of participating infectious diseases centres

INTRODUCTION: Management of pregnancy in women living with HIV is evolving in high-income settings, with increasing attention to infant feeding under sustained virological suppression. Real-world data from Europe remain limited. This study aimed to describe self-reported organizational models and routine approaches to clinical care in participating Italian infectious diseases centres. METHODS: An online survey was conducted among Italian infectious diseases centres via the Italian Cohort of Antiretroviral-Naïve Patients (ICAR) and the Italian Society of Infectious and Tropical Diseases (SIMIT) networks. The questionnaire explored organizational models, ART management, delivery, neonatal prophylaxis and breastfeeding. Data were analysed descriptively. RESULTS: Forty-one centres from 15 regions participated, reporting approximately 300 women living with HIV pregnancies in 2024. Most centres (78.0%) had local pregnancy protocols, typically involving multidisciplinary teams. Reported practices varied across several aspects of care, including ART management during pregnancy, obstetric follow-up, mode of delivery and neonatal prophylaxis. Elective caesarean section (CS) was recommended irrespective of virological status in 9.8% of centres; routine intrapartum intravenous zidovudine was reported in 17.1%. Neonatal zidovudine prophylaxis was used by 90.2% of centres (duration: 2-6 weeks). Requests for breastfeeding were reported by 53.7% of centres; eight centres supported breastfeeding under strict clinical conditions, involving 36 women. CONCLUSIONS: This survey highlights substantial heterogeneity in self-reported organizational models and reported practices among participating Italian infectious diseases centres caring for pregnant women living with HIV. Although direct clinical experience with supported breastfeeding remains limited, the findings support the development of harmonized, evidence-based guidance to promote equitable multidisciplinary care and informed shared decision-making and provide a framework for greater consistency in pregnancy and infant feeding management.