title: HIV-1 reservoirs in breast milk and challenges to elimination of breast-feeding transmission of HIV-1.
abstract: By compensating for the relative immaturity of the neonatal immune system, breast milk and breast-feeding prevent deaths in children. Nevertheless, transmission of HIV-1 through breast-feeding is responsible for more than half of new pediatric HIV infections. Recent studies of possible HIV-1 reservoirs in breast milk shed new light on features that influence HIV-1 transmission through breast-feeding. The particular characteristics of breast milk CD4(+) T cells that distinguish them from circulating blood lymphocytes (high frequency of cell activation and expression of memory and mucosal homing markers) facilitate the establishment of HIV-1 replication. Breast milk also contains a plethora of factors with anti-infectious, immunomodulatory, or anti-inflammatory properties that can regulate both viral replication and infant susceptibility. In addition, CD8(+) T lymphocytes, macrophages, and epithelial cells in breast milk can alter the dynamics of HIV-1 transmission. Even during efficient antiretroviral therapy, a residual stable, CD4(+) T cell-associated reservoir of HIV-1 is persistently present in breast milk, a likely source of infection. Only prophylactic treatment in infants--ideally with a long-acting drug, administered for the entire duration of breast-feeding--is likely to protect HIV-exposed babies against all forms of HIV transmission from breast milk, including cell-to-cell viral transfer.
authors: INSERM U 1058, 34394 Montpellier, France. p-van_de_perre@chumontpellier.fr
authors: Philippe
authors: P
authors: Van de Perre
authors: Pierre-Alain
authors: PA
authors: Rubbo
authors: Johannes
authors: J
authors: Viljoen
authors: Nicolas
authors: N
authors: Nagot
authors: Thorkild
authors: T
authors: Tylleskär
authors: Philippe
authors: P
authors: Lepage
authors: Jean-Pierre
authors: JP
authors: Vendrell
authors: Edouard
authors: E
authors: Tuaillon
mesh_terms: D001942:Breast Feeding / Q000009:adverse effects*; D005260:Female; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008895:Milk, Human / Q000821:virology*