[LUM#12] A treatment that allows for both HIV and breastfeeding
How can you breastfeed your child if you are HIV-positive without risking transmitting HIV to them? Philippe Van de Perre, who has been working on this thorny issue for over 30 years, has developed a protocol that drastically reduce the risk of transmission through breast milk.
Every year, 160,000 newborns are infected with the HIV virus, mainly in Africa. While this figure is three times lower than it was 20 years ago, it is still 160,000 too many for Philippe Van de Perre. The virologist was the first to demonstrate, in 1991, that the virus can be transmitted from mother to child during breastfeeding. “At the time, we were monitoring 212 mothers and their babies in Rwanda, all of whom were HIV-negative at birth. Sixteen months later, 15 mothers had become HIV-positive, as had 8 children.” The only possible explanation: HIV had been transmitted to the infants through breast milk.
Contamination through breast milk
“In one-third of cases, infants become infected through transmission of the virus during childbirth, and in the other two-thirds, during breastfeeding,” explains Philippe Van de Perre. Without treatment, an infant breastfed by an HIV-positive mother has a 30% risk of contracting HIV. This is a major concern, given that without medical care, the mortality rate among infected children reaches 50% during their first year of life. Following these findings,the World Health Organization decided to recommend that women infected with HIV avoid breastfeeding whenever a safe alternative is available. “A recommendation that is impossible to implement in most African countries, for various reasons, whether due to cultural pressure, the cost of formula, or access to clean water…,” explains the specialist.
So how can HIV-positive women breastfeed their babies without risking transmission? Initially, researchers began by giving mothers a treatment designed to eliminate viral particles from breast milk. “Thanks to this treatment, in most cases, we no longer detect the virus in the milk,” explains Philippe Van de Perre. “But despite the maternal treatment, many children continued to contract HIV.”
While researchers note that many breastfeeding mothers do not take their treatment strictly as prescribed—which limits its effectiveness—this is not the only explanation. “We also realized that, in addition to viral particles, breast milk contains cells infected with the virus that are not eliminated by antiretroviral treatment and can transmit the infection to infants,” reveals Philippe Van de Perre.
No side effects
In light of this discovery, the virologist and his team are proposing a new treatment strategy: administering antiretroviral therapy directly to the baby, in addition to the treatment the mother is taking. “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 among babies drops to less than 1%!”
Since December 2019, Philippe Van de Perre has been leading a program in Zambia and Burkina Faso—the only one of its kind in the world—aimed at optimizing the prevention strategy recommended bythe WHO. During routine vaccination visits for newborns aged 6 to 8 weeks, researchers conduct HIV screening tests on all mothers and their babies. “If we find that a mother is HIV-positive and her baby is not infected, we prescribe antiretroviral treatment to the mother, or we intensify it if she is already on treatment. Treatment is also prescribed for the child until the end of breastfeeding.” This very early screening must be accompanied by an information campaign: “To be effective, treatment must be strictly adhered to; it is therefore crucial to inform the mother about the risk of transmission to her baby if treatment is discontinued.”
This ongoing study is being closely monitored by the WHO, which may soon issue new official recommendations to ensure that this protocol is implemented worldwide. “Between this so-called ‘catch-up’ protocol and the new vaccination strategy currently being developed ( see box below), we can now envisage eliminating mother-to-child transmission of HIV.”
Toward a "vaccination" strategy
They are called neutralizing monoclonal antibodies. “These are human antibodies capable of preventing HIV replication ,” explains Philippe Van de Perre. A single injection of these antibodies could provide protection against potential infection for 4 to 6 months. “In regions of the world where HIV is widespread, particularly among young women, we aim to administer an injection of these antibodies to all newborns at birth, then at 4 months, 8 months, and 12 months if the child is still being breastfed.”
This program also applies to babies whose mothers are not HIV-positive at birth: “Indeed, if she contracts the virus while breastfeeding, the newborn is at very high risk. By administering an injection regardless of the mother’s HIV status, we protect all children.” This strategy, known as passive immunoprophylaxis, is already in Phase 2 testing to verify its safety in children.
UM podcasts are now available on your favorite platform (Spotify, Deezer, Apple Podcasts, Amazon Music, etc.).