Scientists have assessed the HIV reservoir present in the breast milk cells of two women living with HIV (WLWH) who had been undergoing effective long-term treatment. This groundbreaking study has been reported by researchers from the University of Buenos Aires
The researchers did not identify any evidence of intact or active HIV that could pose a risk of infection to others; however, the possibility of transmission through breast milk could not be completely excluded (1^✔ ✔Trusted Source
HIV Reservoir Landscape in Breast Milk From Long-Term Virally Suppressed Individuals

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The researchers emphasize that studies of this nature are becoming increasingly significant as guidelines for infant feeding among individuals living with HIV continue to evolve. This concise research report has been published in the Annals of Internal Medicine.

Undetectable Virus in People with HIV Can Still be Transmissible!

The idea that “Undetectable = Untransmittable” (U=U) means people with HIV who have an undetectable viral load can’t pass on the virus. However, this principle hasn’t yet been proven for breastfeeding, as there’s still a very small risk of transmission. For many years, guidelines in wealthy countries focused on avoiding any risk, even tiny ones, by discouraging breastfeeding for people with HIV. Recently, guidelines like the Swiss guidelines and those in the U.S. have started to consider the importance of making informed, shared decisions between patients and doctors.

Why a Need for Revising Guideline for Infant Feeding

The researchers evaluated free virus and cell-associated HIV DNA in breast milk over the first 7 weeks of lactation from an exceptional elite controller (the “Esperanza” patient) with 9 years of spontaneous viral control, from a WLWH receiving ART (abacavir– lamivudine–dolutegravir) with undetectable viral loads for more than 5 years, and a control patient. Very low levels of cellular HIV DNA (0.08 to 0.74 HIV DNA copies per million cells) were detected in the women with HIV; after analyzing 14 million cells from the elite controller, the researchers detected no HIV provirus by full-length individual proviral sequencing, and in 11 million cells from the woman receiving long-term dolutegravir, they detected only 4 defective HIV copies with large internal deletions.

According to the authors, these data are reassuring and support the revised recommendations on infant feeding by PLWH in high resource settings.

Reference:

1. HIV Reservoir Landscape in Breast Milk From Long-Term Virally Suppressed Individuals – (https://www.acpjournals.org/doi/10.7326/ANNALS-24-00085)

Source-Eurekalert