We have observed the development of the HIV pandemic as a disease that has progressively affected more and more women. Globally, since 2004 women represent about 50% of all people living with HIV; most of child-bearing age and in resource poor countries in Africa. The progress in development of HIV treatment and prevention strategies does not include prevention of transmission through breastfeeding. In developed countries milk-borne transmission of HIV-1 is virtually nullified by the easy access to and wide spread use of infant formula, with total avoidance of breastfeeding. Unfortunately, this is not the case in resource-poor countries where the cost of formula is high, where access to it or to a clean water supply can be difficult, or where not breastfeeding stigmatizes women. Therefore, there is a need for safe, simple, and discreet effective strategies that will allow HIV+ mothers to feed their children at the breast. The development of such methods would be of invaluable benefit to mothers and children in Africa, where it is needed the most at this time. It would also be of great benefit for mother-child pairs in developed countries because it would offer them the opportunity of the well-known benefits of breastfeeding. It is the goal of this research proposal to move us closer to this end.
We were the first to report on the possible use of microbicides to treat HIV-infected milk, a concept that is now regarded as a potential breakthrough in HIV/AIDS prevention. Based on the available evidence, we have established parameters to infect human milk in the laboratory that surpass the highest viral loads in milk so far reported, and have been able to mimic infection by cell-free and cell-associated virus. Under these conditions, we have proven the concept that microbicides could be a viable alternative for the prevention of transmission. We reported that 0.01% - 1% SDS (sodium dodecyl sulfate), an ingredient in toothpaste, kills HIV in breast milk in vitro and causes no significant change in milk’s nutritional and immunological factors. Silicone nipple shields – sold over-the-counter for years – are discreet devices applied directly to the breast and can be used for solving problems during breastfeeding (e.g., sore or inverted nipples). In collaboration with an international multidisciplinary team and with funding from the Bill and Melinda Gates Foundation, Dr. Urdaneta Hartmann and her colleagues are modifying a standard nipple shield to hold a non-woven disk containing an edible microbicide, such as SDS, that will inactivate HIV in breast milk. This study is part of a larger study that includes a feasibility study among African women. This research was highlighted in the June/July 2011 issue of the NewsPager.
Selected publications:
"Antiviral Activity of Alkyl Sulfates and the Synthetic Derivate Octylglycerol in Breast Milk for Prevention of HIV-1 Transmission Through Breastfeeding."
Urdaneta Hartmann S., Neely E., Stiller C., Berlin C.M., Wigdahl B., Isaacs C., and M.K. Howett.
In preparation, 2010.
"Inactivation of HIV-1 in Breast Milk with Carrageenan-based Microbicides."
Urdaneta Hartmann S., Neely E., Stiller C., Berlin C.M., Wigdahl B., Phillips D., and M. K. Howett.
In preparation, 2010.
"Letter to the editor (author reply to “Heating breast milk as an infant feeding option”,
Israel-Ballard KA, Chantry CJ, Dewey KG, Donovan RM, Sheppard HW, Abrams BF Urdaneta Hartmann S., Berlin C. M., and M. K. Howett
J. Hum. Lact., 22(3): 267-268, 2006.
"Biochemical Analysis of Breast Milk treated with Alkyl Sulfate Microbicides to Inactivate HIV-1."
Urdaneta Hartmann S., Wigdahl B., Neely E. B., Berlin C. M., Schengrund C.L., Lin H. M., and M K. Howett.
J. Hum. Lact., 22(1): 61-74, 2006.
"Alternative Modified Infant Feeding Practices to Prevent Postnatal Transmission of HIV-1 Through Human Milk: Past, Present and Future."
Urdaneta Hartmann S., Berlin C. M., and M. K. Howett.
J. Hum. Lact., 22(1): 75-88, 2006.
"Microbicidal Treatment of HIV-infected Breast Milk to Prevent Postnatal Mother-to-child Transmission."
Urdaneta S., Wigdahl B., Neely E. B., Berlin C. M., Schengrund C. L., Lin H. M., and M. K. Howett.
Retrovirology, 2: 28, 2005.
"Alkyl Sulfate Microbicidal activity in a Commonly Used Vaginal Preparation". XV International AIDS Conference, 2004.
Howett M.K., Neely E., Ward M., Urdaneta S., and L. Fang.
Monduzzi Editore. Bologna, Italy. pp. 91-94, 2004.
"Microbicidal Treatment of HIV-1 Infected Breast Milk as an Alternative for Prevention of Mother-to -Child Transmission of HIV-1 Through Breastfeeding."
Urdaneta S., Wigdahl B., Neely E.B., Berlin C.M., Schengrund C.L., Lin, H.-M., and M.K. Howett.
Monduzzi Editore, Bologna, Italy, pp. 135-138, 2004.
"Efforts to Prevent Mother-to-child Transmission of Human Immunodeficiency Virus Type I Through Breast milk: Past, Present and Future."
In L.K. Pickering, A.L. Morrow, R.J. Schanler and G.M. Ruîz-Palacios (Editors).
“Protecting Infants Through Human Milk: Advancing the Scientific Evidence Base”.
Urdaneta S., Berlin C. M., and M. K Howett..
Advances in Experimental Medicine and Biology Series. Vol 554, pp. 475-480. Kluwer Academic/Plenum Publishers, New York, NY, 2004.
" Prevention of Mother-to-child Transmission of HIV-1 By Treatment of HIV-1–infected Breast Milk with Alkyl Sulfate Microbicides." XIV International AIDS Conference Proceedings, 2002.
Urdaneta S.L., Berlin C. M., Wigdahl B., and M. K. Howett.
Monduzzi Editore. Bologna, Italy, pp. 135-139, 2002.
|