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\begin{document}

\title{Preventing breastmilk HIV transmission using broadly neutralising
monoclonal antibodies: one size does not fit all}



\author[1]{Philippe Van de Perre}%
\author[2]{Gabriella  Scarlatti}%
\author[3]{Penny Moore L}%
\author[1]{Jean-Pierre Molès}%
\author[1]{Nicolas Nagot}%
\author[4]{Thorkild Tylleskär}%
\author[5]{Glenda Gray}%
\author[5]{Ameena Goga}%
\affil[1]{Montpellier Universite d'Excellence}%
\affil[2]{IRCCS Ospedale San Raffaele}%
\affil[3]{University of the Witwatersrand Johannesburg School of Pathology}%
\affil[4]{Universitetet i Bergen Senter for internasjonal helse}%
\affil[5]{South African Medical Research Council}%


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  \date{May 27, 2024}


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\begin{abstract}
The prospect of preventing HIV infection with broadly neutralising
monoclonal antibodies (bNAbs) has generated unprecedented enthusiasm in
the scientific community and hope among people living with HIV around
the world. HIV bNAbs could be a game changer in the prevention of HIV
acquisition. Some of these bNAbs are being tested in early phase
clinical trials, and the debate is now about the priorities for
strategic large-scale efficacy trials. The prevailing view is that only
a fixed combination of at least three bNAbs could prevent HIV,
regardless of target populations or routes of transmission. We propose
an alternative strategy consisting of evaluating the tolerability and
efficacy of one or two bNAbs cocktails tailored to different target
populations and indications. The rationale for this alternative strategy
is based on ethical, pathophysiological and practical facts and is
illustrated by the possibility of preventing HIV transmission through
breastfeeding in high incidence/prevalence areas such as southern
Africa. There is a prospect of eliminating paediatric HIV acquisition
through breastfeeding by using single/dual long-acting bNAb regimens.%
\end{abstract}%



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