Antiretroviral therapy can profoundly reduce the risk of mother-to-child transmission (MTCT) of HIV, but the drugs have a relatively short half-life and should thus be administered throughout breast-feeding to optimally prevent postnatal infection of the infant. The potential toxicities and the development of resistance may limit the long-term efficacy of antiretroviral prophylaxis, and a safe and effective active/passive immunoprophylaxis regimen, begun at birth, and potentially overlapping with interpartum or neonatal chemoprophylaxis, would pose an attractive alternative. This review draws on data presented at the Ghent Workshop on prevention of breast milk transmission and on selected issues from a workshop specifically relating to immunoprophylaxis held in Seattle in October 2002. This purpose of this review is to address the scientific rationale for the development of passive (antibody) and active (vaccine) immunization strategies for prevention of MTCT. Data regarding currently or imminently available passive and active immunoprophylaxis products are reviewed for their potential use in neonatal trials within the coming 1–2 years.
From *Elizabeth Glaser Pediatric AIDS Foundation, David Geffen School of Medicine, University of California, Los Angeles; †Dana Farber Cancer Institute and Harvard Medical School, Boston, MA; ‡California National Primate Research Center, University of California, Davis; §Seattle Biomedical Research Institute, WA; ¶Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; **University of Massachusetts Medical School, Worcester, MA; ††Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD; ‡‡Office of AIDS Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD; §§Institute of Child Health, University College London, London, UK.
Received for publication June 5, 2003; accepted October 31, 2003
Federal Government disclaimer: The information, opinions, data, and statements contained herein are not necessarily those of the US Government, the Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), or Office of AIDS Research (OAR) and should not be interpreted, acted upon, or represented as such.
Correspondence: Marie-Louise Newell, Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, UK (e-mail: email@example.com).