Research spotlight: Stimulation model shows potential affordability of preventative HIV therapy for infants

Christopher Alba, of the Medical Practice Evaluation Center at Massachusetts General Hospital (MGH) is the lead author and Caitlin Dugdale, MD, MSc of the Division of Infectious Diseases at MGH, is the senior author of a paper published in PLOS One, “Cost-effectiveness of broadly neutralizing antibodies for HIV prophylaxis for infants born in settings with high HIV burdens.”

How would you summarize your study for a lay audience?

HIV infections are lifelong and can weaken the immune system, causing a patient to be more susceptible to infection and various cancers. Children of mothers with HIV are at risk of developing an HIV infection as it is transmittable during labor and while breastfeeding. Despite efforts to improve early maternal HIV diagnosis and increase accessibility of antiretroviral therapy to reduce the risk of transmission from 30% to less than 5%, about 130,000 children acquired HIV globally in 2023.

We evaluated the potential clinical impact and cost-effectiveness of administering long-acting, injectable antibodies, known as “broadly neutralizing antibodies” (bNAbs), to infants from birth to prevent HIV infection during breastfeeding in high-prevalence settings using a computer simulation model. Our results suggest that bNAbs help reduce HIV transmission and could be cost-saving compared to standard-of-care in high HIV burden settings. These findings can help prioritize further investment in the bNAbs that are in development to help achieve the goal of eliminating transmission of HIV to children worldwide.

What question were you investigating?

Our objective was to estimate the potential impact, costs and cost-effectiveness of offering bNAbs to infants in Côte d’Ivoire, South Africa, and Zimbabwe to help inform ongoing research and development of bNAb products and their potential future implementation in high HIV burden settings.

What approach did you use?

We used a computer-based model of HIV infection to simulate offering bNAbs to infants in those three countries, which reflect a wide range of maternal HIV prevalence from 3% in Côte d’Ivoire to 31% in South Africa.

What did you find?

In our analysis, we found that bNAbs could potentially prevent up to 42% of all new infant HIV infections. We also found that in all three settings, offering bNAbs throughout breastfeeding is likely to be cost-saving compared to standard-of-care among infants whose mothers were known to be living with HIV. In settings where maternal HIV prevalence is higher than around 15%, including South Africa, bNAbs are likely to be cost-effective even when offered to all infants in the country, like a vaccine, regardless of if their mother is known to be living with HIV.

What are the implications?

The findings of our study will help funders and policymakers prioritize anti-HIV bNAbs as a feasible and potentially high-value option to reduce the risk of infant HIV infection. As bNAb products become available over the next few years, the results of our study can help inform how best to implement these novel agents to prevent HIV infection among infants in high HIV burden settings around the world.

Authorship: In addition to Alba and Dugdale, Mass General Brigham authors include Stephanie Horsfall, Kenneth A. Freedberg, and Andrea L. Ciaranello.

Paper cited: Alba C et al. “Cost-effectiveness of broadly neutralizing antibodies for HIV prophylaxis for infants born in settings with high HIV burdens” PLOS One DOI: 10.1371/journal.pone.0318940

Funding: This work received funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (K08HD101342 R01HD079214), the National Institute of Allergy and Infectious Disease (NIAID) (R01AI093269), the MGH Research Scholars Award, and the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) (DR808).

Disclosures: Cunningham participated in a RSV advisory board for Sanofi and previously received grants from Gilead, paid to her University, for clinical research. Malhotra, Chapman, Fast, Sok, and Muturi-Kioi are employed by IAVI, a non-profit organization that is pursuing the development of a combination anti-HIV bNAb product. Additional author disclosures can be found in the paper.