Pediatric passive immunization for HIV-prevention: challenges and potential solutions

The development of pediatric prevention strategies against vertical transmission of HIV is essential to finally curb the number of new infections in neonates and infants exposed to HIV right before, during, or after birth. Passive immunization with broadly neutralizing antibodies (bnAbs) is a promising postnatal option. In this review, we summarize the present state of the pediatric epidemic and prevention efforts and discuss current and future bnAb candidates, their pharmacokinetic and pharmacodynamic profiles, their formulation, and existing and new pre-clinical tools, such artificial intelligence and machine learning, that need to be tailored to pediatric cohorts. Furthermore, we highlight the socio-behavioral factors involved in dosing newborns which affect uptake and adherence and therefore cost-effectiveness of the intervention. We finally reflect on the most desirable properties of an effective pediatric prophylactic strategy centered around the use of bnAbs.