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Despite effective treatments, 130,000 infants globally acquired HIV in 2022. Addressing implementation gaps and exploring innovations like long-acting antiretroviral therapy (ART) are crucial for eliminating vertical HIV transmission.

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Area of Science:

  • Infectious Diseases
  • Public Health
  • Virology

Background:

  • Antiretroviral therapy (ART) suppresses HIV, transforming survival for people living with HIV (PLWH) and preventing transmission.
  • Despite current treatments, 130,000 infants globally acquired HIV in 2022, indicating significant implementation gaps in the HIV care cascade.
  • Perinatal HIV acquisition highlights challenges in accessing and sustaining HIV testing, prevention, and treatment services.

Purpose of the Study:

  • To summarize the gaps in the HIV care cascade contributing to vertical HIV transmission.
  • To explore potential novel approaches and therapeutic innovations for eliminating vertical HIV transmission.

Main Methods:

  • Review of current literature on HIV care cascade implementation gaps.
  • Exploration of emerging therapeutic innovations, including long-acting ART and broadly neutralizing antibodies (bNAbs).

Main Results:

  • Multifactorial challenges including accessibility, availability, sustainability, stigma, gender-based violence, and poverty impede the HIV care cascade.
  • Long-acting ART, including injectable forms, shows early promise for tolerability and efficacy during pregnancy for both treatment and prevention.
  • Clinical trials are ongoing for long-acting broadly neutralizing antibodies (bNAbs), with demonstrated safety in selected cases.

Conclusions:

  • Emerging clinical studies must prioritize pregnant and lactating individuals and infants to ensure safety and efficacy of new therapies.
  • Programmatic strategies must integrate therapeutic innovation with solutions for social and economic challenges.
  • Sustainable HIV treatment and prevention programs are essential for the global elimination of blood-borne viruses.