Understanding Viral and Immune Interplay During Vertical Transmission of HIV: Implications for Cure

• Type of Material: Article
• Authors: Omayma Amin, Emory University; Jenna Powers, Emory University; Katherine M Bricker, Emory University; Ann Chahroudi, Emory University
• Language: English
• Date: 2021-10-21
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Amin, Powers, Bricker and Chahroudi
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fimmu.2021.757400
• Title of Journal or Parent Work: FRONTIERS IN IMMUNOLOGY
• Volume: 12
• Start Page: 757400
• End Page: 757400
• Grant/Funding Information: AC would like to acknowledge funding support from the NIH (R01 AI133706, P01 AI131276, R37 AI157862, and UM1 AI164566).
• Keywords: breast milk; MATERNAL-INFANT TRANSMISSION; ELECTIVE CESAREAN-SECTION; MOTHER-TO-CHILD; Immunology; antiretroviral; HIV; HEPATITIS-C VIRUS; HUMAN-IMMUNODEFICIENCY-VIRUS; reservoir; CELL-ASSOCIATED HIV-1; PERINATAL TRANSMISSION; MTCT; PLASMODIUM-FALCIPARUM MALARIA; Life Sciences & Biomedicine; shock and kill; COMBINATION ANTIRETROVIRAL THERAPY; HERPES-SIMPLEX-VIRUS; Science & Technology; pediatric; cure
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Despite the significant progress that has been made to eliminate vertical HIV infection, more than 150,000 children were infected with HIV in 2019, emphasizing the continued need for sustainable HIV treatment strategies and ideally a cure for children. Mother-to-child-transmission (MTCT) remains the most important route of pediatric HIV acquisition and, in absence of prevention measures, transmission rates range from 15% to 45% via three distinct routes: in utero, intrapartum, and in the postnatal period through breastfeeding. The exact mechanisms and biological basis of these different routes of transmission are not yet fully understood. Some infants escape infection despite significant virus exposure, while others do not, suggesting possible maternal or fetal immune protective factors including the presence of HIV-specific antibodies. Here we summarize the unique aspects of HIV MTCT including the immunopathogenesis of the different routes of transmission, and how transmission in the antenatal or postnatal periods may affect early life immune responses and HIV persistence. A more refined understanding of the complex interaction between viral, maternal, and fetal/infant factors may enhance the pursuit of strategies to achieve an HIV cure for pediatric populations.