In the absence of any intervention, rate of mother to child transmission (MTCT) of HIV-1 is about 40%. With ART intervention this rate of MTCT can be reduced to lower than 5%. However, access, adherence, resistance, and toxicity to ART remains an important issue in preventing MTCT. Hence, there is an urgent need for interventions that can synergize with ART. Our study shows that escape of maternal antibody neutralization, potentially at the variable loop 3 (V3) region and membrane proximal external region (MPER) play a significant role in selecting maternal variants causing infections in infants. Active targeting of viruses resistant to maternal antibodies via direct immunization or passive therapies, such as VRC01 like broadly-neutralizing antibodies, could help elminate MTCT.
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