Journal article
Antiretroviral Drug Concentrations in Breastmilk, Maternal HIV Viral Load, and HIV Transmission to the Infant: Results From the BAN Study
Journal of acquired immune deficiency syndromes (1999), Vol.80(4), pp.467-473
04/01/2019
DOI: 10.1097/QAI.0000000000001941
PMCID: PMC6391211
PMID: 30570527
Abstract
Concentration of antiretroviral (ARV) drug found in plasma, and amounts of drug excreted into breastmilk, may affect HIV viral load and potentially perinatal HIV transmission.
In this cohort study with 2-phase sampling, we included mothers randomized to postpartum maternal ARVs or daily infant nevirapine during 28 weeks of breastfeeding in the Breastfeeding, Antiretrovirals, and Nutrition study. Among these, we included all mothers who transmitted HIV to their infants between 2 and 28 weeks and 15% of mothers who did not (n = 27 and 227, respectively). Spearman correlation coefficients (r) were used to assess the correlation between maternal plasma and breastmilk ARV concentration. Associations between the median effective drug concentration (EC50) and detectable maternal viral load (plasma: >40 copies per milliliter, breastmilk: >56 copies per milliliter) were assessed using mixed-effects models. Cox models were used to estimate the association between maternal or infant plasma drug concentration and breastmilk HIV transmission from 2 to 28 weeks.
All ARV compounds exhibited substantial correlations between maternal plasma and breastmilk concentrations (r: 0.85-0.98, P-value <0.0001). Having plasma drug concentration above the EC50 was associated with lower odds of having detectable HIV RNA [maternal plasma odds ratio (OR) 0.64, 95% confidence interval (CI): 0.45 to 0.91; breastmilk OR 0.22, 95% CI: 0.14 to 0.35] and a reduced rate of breastmilk HIV transmission (hazard ratio 0.40, 95% CI: 0.18 to 0.93). Having breastmilk drug concentration above the EC50 was also associated with lower odds of having detectable maternal HIV RNA (plasma OR 0.62, 95% CI: 0.45 to 0.85; breastmilk OR 0.42, 95% CI: 0.29 to 0.59).
Ensuring adequate drug concentration is important for viral suppression and preventing breastmilk HIV transmission.
Details
- Title: Subtitle
- Antiretroviral Drug Concentrations in Breastmilk, Maternal HIV Viral Load, and HIV Transmission to the Infant: Results From the BAN Study
- Creators
- Nicole L Davis - Centers for Disease Control and PreventionAmanda Corbett - University of North Carolina at Chapel HillJosh Kaullen - University of North Carolina at Chapel HillJulie A E Nelson - University of North Carolina at Chapel HillCharles S Chasela - University of the WitwatersrandDorothy Sichali - UNC Project Malawi, Lilongwe, MalawiMichael G Hudgens - University of North Carolina at Chapel HillWilliam C Miller - The Ohio State UniversityDenise J Jamieson - Centers for Disease Control and PreventionAthena P Kourtis - Centers for Disease Control and PreventionBreastfeeding, Antiretrovirals and Nutrition (BAN) Study Team
- Resource Type
- Journal article
- Publication Details
- Journal of acquired immune deficiency syndromes (1999), Vol.80(4), pp.467-473
- DOI
- 10.1097/QAI.0000000000001941
- PMID
- 30570527
- PMCID
- PMC6391211
- ISSN
- 1525-4135
- eISSN
- 1944-7884
- Grant note
- R56 AI091547 / NIAID NIH HHS T32 AI070114 / NIAID NIH HHS CC999999 / Intramural CDC HHS D43 TW001039 / FIC NIH HHS R24 TW007988 / FIC NIH HHS P30 AI050410 / NIAID NIH HHS R03 AI100694 / NIAID NIH HHS U48DP001944 / ACL HHS U01 AI068632 / NIAID NIH HHS U48 DP000059 / NCCDPHP CDC HHS
- Language
- English
- Date published
- 04/01/2019
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446522902771
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