Department of Infectious Disease, Imperial College London, Imperial College NIHR BRC.
Chelsea and Westminster Hospital NHS Foundation Trust.
Curr Opin HIV AIDS. 2024 Nov 1;19(6):293-304. doi: 10.1097/COH.0000000000000881. Epub 2024 Aug 21.
Although current treatment could eradicate vertical transmission, in 2022, 130 000 infants acquired HIV globally. HIV suppression with antiretroviral therapy (ART) transforms survival for people living with HIV (PLWH), and prevents transmission, including vertical. International guidelines recommend lifelong ART for PLWH, consequently perinatal HIV acquisition reflects implementation gaps in the HIV care cascade. We summarize these gaps, exploring potential novel approaches and therapeutic innovations towards eliminating vertical HIV transmission.
Multifactorial challenges continue to underpin gaps in the HIV care cascade, including accessibility, availability and sustainability of HIV testing, prevention and treatment, alongside stigma, gender-based violence and poverty. Long-acting ART may be important in preventing perinatal HIV acquisition, with early data demonstrating tolerability and efficacy of injectable ART throughout pregnancy, both as HIV treatment and prevention. Carefully selected long-acting broadly neutralizing antibodies (bNAbs) matching circulating, exposing viral envelope sequences have demonstrated safety, clinical trials are ongoing to demonstrate efficacy.
Emerging clinical studies should prioritize pregnant/lactating people and infants to ensure such therapies are well tolerated and efficacious. Alongside therapeutic innovation, programmatic strategies must address social and economic challenges, ensuring sustainable HIV treatment/prevention programmes and facilitating global elimination of blood-borne viruses.
目的综述：尽管目前的治疗方法可以消除垂直传播，但 2022 年全球仍有 13 万名婴儿感染了 HIV。抗逆转录病毒疗法（ART）抑制 HIV 可改变 HIV 感染者（PLWH）的生存状况，并可预防传播，包括垂直传播。国际指南建议 PLWH 终身接受 ART，因此围产期 HIV 感染反映了 HIV 护理链中的实施差距。我们总结了这些差距，探讨了消除垂直 HIV 传播的潜在新方法和治疗创新。
最新发现：多因素挑战继续成为 HIV 护理链中的差距的基础，包括 HIV 检测、预防和治疗的可及性、可获得性和可持续性，以及耻辱感、性别暴力和贫困。长效 ART 可能对预防围产期 HIV 感染很重要，早期数据表明，整个孕期注射用 ART 的耐受性和疗效良好，无论是作为 HIV 治疗还是预防。精心选择的与循环中暴露的病毒包膜序列相匹配的长效广泛中和抗体（bNAb）已被证明是安全的，临床试验正在进行中以证明其疗效。
总结：正在进行的临床研究应优先考虑孕妇/哺乳期妇女和婴儿，以确保这些疗法具有良好的耐受性和疗效。除了治疗创新，还必须制定方案策略来解决社会和经济挑战，确保可持续的 HIV 治疗/预防方案，并促进全球消除血源病毒。
