Cost-effectiveness of broadly neutralizing antibodies for infant HIV prophylaxis in settings with high HIV burdens: a simulation modeling study.

Approximately 130 000 infants acquire HIV annually despite global maternal antiretroviral therapy scale-up. We evaluated the potential clinical impact and cost-effectiveness of offering long-acting, anti-HIV broadly neutralizing antibody (bNAb) prophylaxis to infants in three distinct settings. We simulated infants in Côte d'Ivoire, South Africa, and Zimbabwe using the Cost-Effectiveness of Preventing AIDS Complications-Pediatric (CEPAC-P) model. We modeled strategies offering a three-bNAb combination in addition to WHO-recommended standard-of-care oral prophylaxis to infants: a) with known, WHO-defined high-risk HIV exposure at birth ( The base case model projects that bNAb strategies targeting Adding long-acting bNAbs to current standard-of-care prophylaxis would be cost-effective, assuming plausible efficacies and costs. The cost-effective target population would vary by setting, largely driven by maternal antenatal HIV prevalence and postpartum incidence.

Déclaration de conflit d'intérêts

Conflicts of Interest: SP is a consultant for Merck, Moderna, Pfizer, Dynavax, Hoopika, and GSK, and has a sponsored research program with Moderna and Merck in the area of cytomegalovirus (CMV) vaccines. AG is a co-PI on COVID-vaccine studies funded through the SAMRC by the HIV vaccine trials network, EDCTP, ANRS, ImmunityBio, Janssen, and Moderna. AB and EJF receive funding from IMPAACT and AB receives funding from Unitaid for trials evaluating non-bNAb approaches to maternal-infant HIV prophylaxis. CKC participated in a RSV advisory board for Sanofi and previously received grants from Gilead, paid to her University, for clinical research. SM, KC, PEF, DS, and VMK are employed by IAVI, a non-profit organization that is pursuing the development of a combination anti-HIV bNAb product. No other authors report conflicts of interest.