Transfer of antiretroviral drugs into breastmilk: a prospective study from the Swiss Mother and Child HIV Cohort Study
In 2018, Switzerland changed its guidelines to support women living with HIV wishing to breastfeed. The exposure of antiretroviral drugs (ARVs) in breastmilk and the ingested daily dose by the breastfed infant are understudied, notably for newer ARVs. This study aimed to quantify ARV concentrations...
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| Veröffentlicht in: | Journal of antimicrobial chemotherapy 2022-11, Vol.77 (12), p.3436-3442 |
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| container_title | Journal of antimicrobial chemotherapy |
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| creator | Aebi-Popp, Karoline Kahlert, Christian R Crisinel, Pierre-Alex Decosterd, Laurent Saldanha, Susana Alves Hoesli, Irene Martinez De Tejada, Begona Duppenthaler, Andrea Rauch, Andri Marzolini, Catia |
| description | In 2018, Switzerland changed its guidelines to support women living with HIV wishing to breastfeed. The exposure of antiretroviral drugs (ARVs) in breastmilk and the ingested daily dose by the breastfed infant are understudied, notably for newer ARVs. This study aimed to quantify ARV concentrations in maternal plasma and breastmilk to determine the milk/plasma ratio, to estimate daily infant ARV dose from breastfeeding and to measure ARV concentrations in infants.
All women wishing to breastfeed were included, regardless of their ARV treatment. Breastmilk and maternal plasma samples were mostly collected at mid-dosing interval.
Twenty-one mother/child pairs were enrolled; of those several were on newer ARVs including 10 raltegravir, 1 bictegravir, 2 rilpivirine, 2 darunavir/ritonavir and 3 tenofovir alafenamide. No vertical HIV transmission was detected (one infant still breastfed). The median milk/plasma ratios were 0.96/0.39 for raltegravir once/twice daily, 0.01 for bictegravir, 1.08 for rilpivirine, 0.12 for darunavir/ritonavir and 4.09 for tenofovir alafenamide. The median estimated infant daily dose (mg/kg) from breastfeeding was 0.02/0.25 for raltegravir once/twice daily, 0.01 for bictegravir, 0.02 for rilpivirine, 0.05 for darunavir/ritonavir and 0.007 for tenofovir alafenamide, resulting in relative infant dose |
| doi_str_mv | 10.1093/jac/dkac337 |
| format | Article |
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All women wishing to breastfeed were included, regardless of their ARV treatment. Breastmilk and maternal plasma samples were mostly collected at mid-dosing interval.
Twenty-one mother/child pairs were enrolled; of those several were on newer ARVs including 10 raltegravir, 1 bictegravir, 2 rilpivirine, 2 darunavir/ritonavir and 3 tenofovir alafenamide. No vertical HIV transmission was detected (one infant still breastfed). The median milk/plasma ratios were 0.96/0.39 for raltegravir once/twice daily, 0.01 for bictegravir, 1.08 for rilpivirine, 0.12 for darunavir/ritonavir and 4.09 for tenofovir alafenamide. The median estimated infant daily dose (mg/kg) from breastfeeding was 0.02/0.25 for raltegravir once/twice daily, 0.01 for bictegravir, 0.02 for rilpivirine, 0.05 for darunavir/ritonavir and 0.007 for tenofovir alafenamide, resulting in relative infant dose <10% exposure index for all ARVs.
ARVs were transferred to a variable extent in breastmilk. Nevertheless, the estimated daily ARV dose from breastfeeding remained low. Differential ARV exposure was observed in breastfed infants with some ARVs being below/above their effective concentrations raising the concern of resistance development if HIV infection occurs. More data on this potential risk are warranted to better support breastfeeding.</description><identifier>ISSN: 0305-7453</identifier><identifier>ISSN: 1460-2091</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkac337</identifier><identifier>PMID: 36177836</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Anti-HIV Agents - therapeutic use ; Anti-Retroviral Agents - therapeutic use ; Cohort Studies ; Darunavir - therapeutic use ; Female ; HIV Infections ; Humans ; Infant ; Milk, Human ; Mothers ; Original Research ; Prospective Studies ; Raltegravir Potassium - therapeutic use ; Rilpivirine - therapeutic use ; Ritonavir - therapeutic use ; Switzerland</subject><ispartof>Journal of antimicrobial chemotherapy, 2022-11, Vol.77 (12), p.3436-3442</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-f51f74ce0abee2360261d87ff666dce64ce471dba6a7566d91a3564177eb25523</citedby><cites>FETCH-LOGICAL-c381t-f51f74ce0abee2360261d87ff666dce64ce471dba6a7566d91a3564177eb25523</cites><orcidid>0000-0002-2312-7050 ; 0000-0002-9840-1325</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36177836$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aebi-Popp, Karoline</creatorcontrib><creatorcontrib>Kahlert, Christian R</creatorcontrib><creatorcontrib>Crisinel, Pierre-Alex</creatorcontrib><creatorcontrib>Decosterd, Laurent</creatorcontrib><creatorcontrib>Saldanha, Susana Alves</creatorcontrib><creatorcontrib>Hoesli, Irene</creatorcontrib><creatorcontrib>Martinez De Tejada, Begona</creatorcontrib><creatorcontrib>Duppenthaler, Andrea</creatorcontrib><creatorcontrib>Rauch, Andri</creatorcontrib><creatorcontrib>Marzolini, Catia</creatorcontrib><creatorcontrib>Swiss Mother and Child HIV Cohort Study (SHCS)</creatorcontrib><creatorcontrib>Swiss Mother and Child HIV Cohort Study (SHCS)</creatorcontrib><title>Transfer of antiretroviral drugs into breastmilk: a prospective study from the Swiss Mother and Child HIV Cohort Study</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>In 2018, Switzerland changed its guidelines to support women living with HIV wishing to breastfeed. The exposure of antiretroviral drugs (ARVs) in breastmilk and the ingested daily dose by the breastfed infant are understudied, notably for newer ARVs. This study aimed to quantify ARV concentrations in maternal plasma and breastmilk to determine the milk/plasma ratio, to estimate daily infant ARV dose from breastfeeding and to measure ARV concentrations in infants.
All women wishing to breastfeed were included, regardless of their ARV treatment. Breastmilk and maternal plasma samples were mostly collected at mid-dosing interval.
Twenty-one mother/child pairs were enrolled; of those several were on newer ARVs including 10 raltegravir, 1 bictegravir, 2 rilpivirine, 2 darunavir/ritonavir and 3 tenofovir alafenamide. No vertical HIV transmission was detected (one infant still breastfed). The median milk/plasma ratios were 0.96/0.39 for raltegravir once/twice daily, 0.01 for bictegravir, 1.08 for rilpivirine, 0.12 for darunavir/ritonavir and 4.09 for tenofovir alafenamide. The median estimated infant daily dose (mg/kg) from breastfeeding was 0.02/0.25 for raltegravir once/twice daily, 0.01 for bictegravir, 0.02 for rilpivirine, 0.05 for darunavir/ritonavir and 0.007 for tenofovir alafenamide, resulting in relative infant dose <10% exposure index for all ARVs.
ARVs were transferred to a variable extent in breastmilk. Nevertheless, the estimated daily ARV dose from breastfeeding remained low. Differential ARV exposure was observed in breastfed infants with some ARVs being below/above their effective concentrations raising the concern of resistance development if HIV infection occurs. More data on this potential risk are warranted to better support breastfeeding.</description><subject>Anti-HIV Agents - therapeutic use</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Cohort Studies</subject><subject>Darunavir - therapeutic use</subject><subject>Female</subject><subject>HIV Infections</subject><subject>Humans</subject><subject>Infant</subject><subject>Milk, Human</subject><subject>Mothers</subject><subject>Original Research</subject><subject>Prospective Studies</subject><subject>Raltegravir Potassium - therapeutic use</subject><subject>Rilpivirine - therapeutic use</subject><subject>Ritonavir - therapeutic use</subject><subject>Switzerland</subject><issn>0305-7453</issn><issn>1460-2091</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUU1PwzAMjRCIjY8Td5QjEiokTZpsHJDQxMckEAc-rlHaOlugbUaSDvHvycSY4GTLfn7P9kPoiJIzSsbs_E1X5_W7rhiTW2hIuSBZTsZ0Gw0JI0UmecEGaC-EN0KIKMRoFw2YoFKOmBii5bPXXTDgsTNYd9F6iN4trdcNrn0_C9h20eHSgw6xtc37BdZ44V1YQBXtEnCIff2FjXctjnPAT582BPzgUu4TX40nc9vU-G76iidu7nzET6uBA7RjdBPgcB330cvN9fPkLrt_vJ1Oru6zio1ozExBjeQVEF0C5EyQXNB6JI0RQtQViNTiktalFloWqTSmmhWCp-OgzIsiZ_vo8od30ZctpJEupsvUwttW-y_ltFX_O52dq5lbqrEknDOeCE7WBN599BCiam2ooGl0B64PKpc54YwJvtI6_YFW6T3Bg9nIUKJWTqnklFo7ldDHfzfbYH-tYd-d65MB</recordid><startdate>20221128</startdate><enddate>20221128</enddate><creator>Aebi-Popp, Karoline</creator><creator>Kahlert, Christian R</creator><creator>Crisinel, Pierre-Alex</creator><creator>Decosterd, Laurent</creator><creator>Saldanha, Susana Alves</creator><creator>Hoesli, Irene</creator><creator>Martinez De Tejada, Begona</creator><creator>Duppenthaler, Andrea</creator><creator>Rauch, Andri</creator><creator>Marzolini, Catia</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2312-7050</orcidid><orcidid>https://orcid.org/0000-0002-9840-1325</orcidid></search><sort><creationdate>20221128</creationdate><title>Transfer of antiretroviral drugs into breastmilk: a prospective study from the Swiss Mother and Child HIV Cohort Study</title><author>Aebi-Popp, Karoline ; Kahlert, Christian R ; Crisinel, Pierre-Alex ; Decosterd, Laurent ; Saldanha, Susana Alves ; Hoesli, Irene ; Martinez De Tejada, Begona ; Duppenthaler, Andrea ; Rauch, Andri ; Marzolini, Catia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-f51f74ce0abee2360261d87ff666dce64ce471dba6a7566d91a3564177eb25523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anti-HIV Agents - therapeutic use</topic><topic>Anti-Retroviral Agents - therapeutic use</topic><topic>Cohort Studies</topic><topic>Darunavir - therapeutic use</topic><topic>Female</topic><topic>HIV Infections</topic><topic>Humans</topic><topic>Infant</topic><topic>Milk, Human</topic><topic>Mothers</topic><topic>Original Research</topic><topic>Prospective Studies</topic><topic>Raltegravir Potassium - therapeutic use</topic><topic>Rilpivirine - therapeutic use</topic><topic>Ritonavir - therapeutic use</topic><topic>Switzerland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aebi-Popp, Karoline</creatorcontrib><creatorcontrib>Kahlert, Christian R</creatorcontrib><creatorcontrib>Crisinel, Pierre-Alex</creatorcontrib><creatorcontrib>Decosterd, Laurent</creatorcontrib><creatorcontrib>Saldanha, Susana Alves</creatorcontrib><creatorcontrib>Hoesli, Irene</creatorcontrib><creatorcontrib>Martinez De Tejada, Begona</creatorcontrib><creatorcontrib>Duppenthaler, Andrea</creatorcontrib><creatorcontrib>Rauch, Andri</creatorcontrib><creatorcontrib>Marzolini, Catia</creatorcontrib><creatorcontrib>Swiss Mother and Child HIV Cohort Study (SHCS)</creatorcontrib><creatorcontrib>Swiss Mother and Child HIV Cohort Study (SHCS)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aebi-Popp, Karoline</au><au>Kahlert, Christian R</au><au>Crisinel, Pierre-Alex</au><au>Decosterd, Laurent</au><au>Saldanha, Susana Alves</au><au>Hoesli, Irene</au><au>Martinez De Tejada, Begona</au><au>Duppenthaler, Andrea</au><au>Rauch, Andri</au><au>Marzolini, Catia</au><aucorp>Swiss Mother and Child HIV Cohort Study (SHCS)</aucorp><aucorp>Swiss Mother and Child HIV Cohort Study (SHCS)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transfer of antiretroviral drugs into breastmilk: a prospective study from the Swiss Mother and Child HIV Cohort Study</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2022-11-28</date><risdate>2022</risdate><volume>77</volume><issue>12</issue><spage>3436</spage><epage>3442</epage><pages>3436-3442</pages><issn>0305-7453</issn><issn>1460-2091</issn><eissn>1460-2091</eissn><abstract>In 2018, Switzerland changed its guidelines to support women living with HIV wishing to breastfeed. The exposure of antiretroviral drugs (ARVs) in breastmilk and the ingested daily dose by the breastfed infant are understudied, notably for newer ARVs. This study aimed to quantify ARV concentrations in maternal plasma and breastmilk to determine the milk/plasma ratio, to estimate daily infant ARV dose from breastfeeding and to measure ARV concentrations in infants.
All women wishing to breastfeed were included, regardless of their ARV treatment. Breastmilk and maternal plasma samples were mostly collected at mid-dosing interval.
Twenty-one mother/child pairs were enrolled; of those several were on newer ARVs including 10 raltegravir, 1 bictegravir, 2 rilpivirine, 2 darunavir/ritonavir and 3 tenofovir alafenamide. No vertical HIV transmission was detected (one infant still breastfed). The median milk/plasma ratios were 0.96/0.39 for raltegravir once/twice daily, 0.01 for bictegravir, 1.08 for rilpivirine, 0.12 for darunavir/ritonavir and 4.09 for tenofovir alafenamide. The median estimated infant daily dose (mg/kg) from breastfeeding was 0.02/0.25 for raltegravir once/twice daily, 0.01 for bictegravir, 0.02 for rilpivirine, 0.05 for darunavir/ritonavir and 0.007 for tenofovir alafenamide, resulting in relative infant dose <10% exposure index for all ARVs.
ARVs were transferred to a variable extent in breastmilk. Nevertheless, the estimated daily ARV dose from breastfeeding remained low. Differential ARV exposure was observed in breastfed infants with some ARVs being below/above their effective concentrations raising the concern of resistance development if HIV infection occurs. More data on this potential risk are warranted to better support breastfeeding.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>36177836</pmid><doi>10.1093/jac/dkac337</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-2312-7050</orcidid><orcidid>https://orcid.org/0000-0002-9840-1325</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of antimicrobial chemotherapy, 2022-11, Vol.77 (12), p.3436-3442 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection; Free Full-Text Journals in Chemistry |
| subjects | Anti-HIV Agents - therapeutic use Anti-Retroviral Agents - therapeutic use Cohort Studies Darunavir - therapeutic use Female HIV Infections Humans Infant Milk, Human Mothers Original Research Prospective Studies Raltegravir Potassium - therapeutic use Rilpivirine - therapeutic use Ritonavir - therapeutic use Switzerland |
| title | Transfer of antiretroviral drugs into breastmilk: a prospective study from the Swiss Mother and Child HIV Cohort Study |
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