Breastmilk erythropoietin and mother-to-child HIV transmission through breastmilk

A third to a half the 1•5 million HIV-positive children in the world today acquired their infection via breastfeeding. However, what protects the 85% of breastfed babies of HIV-infected mothers who do not become infected? We postulate that erythropoietin (EPO), a hormone in human milk, has a role in the prevention of HIV transmission during breastfeeding. EPO might maintain mammary epithelium integrity, thereby reducing viral loads in milk, or maintain intestinal epithelial integrity in the breastfed neonate, and thus preventing ingested milk-borne virus being infective. This hypothesis could be tested by administration of recombinant human EPO parenterally to HIV-infected mothers or enterally to breastfed babies, or both, and assessment of the effect on mammary permeability, viral load in milk, and intestinal permeability in babies. If our hypothesis is correct, EPO treatment for mother or baby, or both might help prevent transmission of HIV.