Long-term HIV control and breastfeeding: HIV DNA in breast milk cells from an exceptional elite controller and a woman on-ART. Are we ready to change the paradigm?

ARIEL OSEGUEDA; LUCIA BAQUERO; ALEJANDRO CZERNIKIER; CINTHIA MENDEZ; YANINA GHIGLIONE; GABRIELA TURK; NATALIA LAUFER

Conferencia; 12th IAS Conference on HIV Science; 2023

International AIDS Society

Background: HIV has been found to be present in breastmilk, even in the context of antiretroviral therapy (ART).Formula feeding is safe in high-income settings, therefore, women living with HIV (WLWH) are advised againstbreastfeeding and this recommendation has notchanged over time.However, WLWH with fully suppressed viral loads and exceptional elite controllers are challenging these guidelines and even choosing to breastfeed.Here we aimed to study the HIV RNA and reservoir presentin breast milk from an exceptional elite controller (EEC,the “Esperanza patient”) and to compare it with anotherAuthorIndexLate-breakerabstractsE-postersOralabstractsPosterexhibition71 Abstract book ias2023.orgwoman who has been under ART with dolutegravir, lamivudina and abacavir since march 2016 (WLWH-on-ART),maintaining undetectability for over 69 months.Methods: 5.65 liters of breast milk from the first sevenweeks of lactation were processed from the EEC, and 411mL from WLWH-on-ART. Milk was centrifuged and the fluidportion (556 ml from EEC, 146 ml from WLWH-on-ART) wasultracentrifuged and used to determine HIV viral load(VL).Also, 1,443 billion cells from EEC and 36.6 million cells fromWLWH-on-ART were obtained. DNA was extracted and total HIV DNA qPCR and FLIP assays were performed.Results: Breast milk VL was undetectable (