title: Vaccines to prevent transmission of HIV-1 via breastmilk: scientific and logistical priorities.
abstract: Mother-to-child transmission (MTCT) of HIV-1 is the major mode of paediatric infection. The rapidly increasing incidence of MTCT worldwide has resulted in an urgent need for preventive strategies. Antiretroviral regimens can prevent intrapartum HIV transmission; however, these regimens do not prevent HIV transmission through breastfeeding. Furthermore, children who escape MTCT are again at risk of infection when they become sexually active as adolescents. An infant vaccine regimen, begun at birth, would hence be a more attractive strategy and might also provide the basis for lifetime protection. Unique features of MTCT and paediatric HIV disease could be helpful in understanding correlates of immune protection and could facilitate rapid assessment of vaccine efficacy. Thus, there is compelling rationale to develop safe, effective HIV vaccines for use in infants and children. Here, we discuss the scientific and logistical challenges for the development of paediatric HIV vaccines; available vaccines and completed or planned paediatric vaccine trials are also discussed.
authors.affiliation: University of Massachusetts Medical School, Program in Molecular Medicine, 373 Plantation Street, Suite 318, Worcester, MA 01605, USA. katherine.luzuriaga@umassmed.edu
authors.forename: Katherine
authors.initials: K
authors.lastname: Luzuriaga
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Excler
authors.forename: John L
authors.initials: JL
authors.lastname: Sullivan
mesh_terms: D016915:AIDS Vaccines / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000818:Animals; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000517:prevention & control / Q000635:transmission; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008895:Milk, Human / Q000821:virology*; D010372:Pediatrics; D015995:Prevalence; D011994:Recombinant Proteins / Q000276:immunology
chemical_list: D016915:AIDS Vaccines; D011994:Recombinant Proteins