Preventing breast milk HIV transmission using broadly neutralizing monoclonal antibodies: One size does not fit all

Immun Inflamm Dis. 2024 Mar;12(3):e1216. doi: 10.1002/iid3.1216.

¹ Pathogenesis and Control of Chronic and Emerging Infections, INSERM, Etablissement Français du Sang, CHU Montpellier, University of Montpellier, Montpellier, France.
² Viral Evolution and Transmission Unit, IRCCS Ospedale San Raffaele, Milan, Italy.
³ MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
⁴ National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.
⁵ Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
⁶ South African Medical Research Council, Cape Town, South Africa.
⁷ Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa.

Abstract

Passive immunoprophylaxis with broadly neutralizing monoclonal antibodies (bNAbs) could be a game changer in the prevention of human immunodeficiency virus (HIV) acquisition.
The prevailing view is that available resources should be focused on identifying a fixed combination of at least three bNAbs for universal use in therapeutic and preventive protocols, regardless of target populations or routes of transmission.
HIV transmission through breastfeeding is unique: it involves free viral particles and cell‐associated virus from breast milk and, in the case of acute/recent maternal infection, a viral population with restricted Env diversity.
HIV transmission through breastfeeding in high incidence/prevalence areas could potentially be eliminated by subcutaneous administration to all newborns of one or two long‐acting bNAbs with extended breadth, high potency, and effector properties (ADCC, phagocytosis) against circulating HIV strains.

Keywords: antibodies molecules; human animals; viral/retroviral infections.