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

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.