A treatment to combine AIDS and breastfeeding

How can you breastfeed your HIV-positive child without risking HIV? Philippe Van de Perre, who has been working on this thorny this thorny issue for over 30 years, has developed a protocol that drastically drastically reduce the risk of contamination via breast milk.

Taking "preventive tritherapy" while breastfeeding can halve the probability of mother-to-child transmission of HIV. IRD

Every year, 160,000 newborn babies are infected with the AIDS virus, mainly in Africa. While this is 3 times less than 20 years ago, it's still 160,000 too many for Philippe Van de Perre. In 1991, the virologist was the first to highlight the fact that the virus can be transmitted from mother to child during breastfeeding. "At the time, we were following 212 mothers and their babies in Rwanda, all of whom were HIV-negative at delivery. Sixteen months later, 15 mothers had become HIV-positive, as had 8 children. The only possible explanation: HIV had been transmitted to infants via breast milk.

Contamination through breast milk

"In one-third of cases, babies are infected through transmission of the virus during childbirth, and the other two-thirds through breastfeeding," explains Philippe Van de Perre. In the absence of treatment, an infant breastfed by an HIV-positive mother has a 30% risk of contracting HIV. This is a major challenge when you consider that, without medical care, the mortality rate of infected children reaches 50% in their first year. Following these revelations, theWorld Health Organization decided to recommend that HIV-infected women avoid breastfeeding when a safe alternative is available. " This recommendation is impossible to apply in most African countries, for a variety of reasons, including cultural pressure, the cost of formula milk and access to drinking water," explains the specialist.

So how do you enable HIV-positive women to breastfeed their babies without risking contamination? Researchers began by giving mothers a treatment designed to remove viral particles from breast milk. Thanks to this treatment, in most cases we no longer detected the virus in the milk," explains Philippe Van de Perre. But despite maternal treatment, many children continued to contract HIV.
While the researchers found that many breastfeeding mothers did not take their treatment scrupulously, thus limiting its effectiveness, this was not the only explanation. " We also found that, in addition to viral particles, breast milk contains virus-infected cells which are not eliminated by antiretroviral treatment and can transmit the infection to infants", reveals Philippe Van de Perre.

No side effects

Faced with this discovery, the virologist and his team proposed a new therapeutic strategy: administering antiretroviral treatment directly to the baby, in addition to the treatment taken by the mother. "It's a simple pediatric syrup given to the child, the treatment is very well tolerated and we haven't observed any side effects. And the results speak for themselves: with this new protocol, the infection rate in babies has fallen to less than 1%!"

Since December 2019, Philippe Van de Perre has been running a unique program in Zambia and Burkina-Faso aimed at optimizing the prevention strategy recommended by theWHO. During the vaccination visit for newborns aged between 6 and 8 weeks, researchers test all mothers and their babies for AIDS. "If a mother is found to be HIV-positive and her baby is uninfected, the mother is prescribed antiretroviral treatment, or her treatment is reinforced if she is already on it. We also prescribe treatment for the child until the end of breastfeeding. This very early detection must be accompanied by an information campaign: "to be effective, treatment must be properly followed up, so it's vital to inform the mother of the risk of contamination to her baby if treatment is stopped".

This ongoing study is being closely watched by the WHO, which may soon draw up new official recommendations to ensure that this protocol is applied worldwide. " Between this "catch-up" protocol and the new vaccine strategy we are developing (see box below), we can now envisage eliminating mother-to-child transmission of HIV".