Skip to main content
SpringerLink
Log in

Antiretroviral Pharmacology in Breast Milk

  • Chapter
  • First Online:
Human Immunodeficiency Virus type 1 (HIV-1) and Breastfeeding

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 743))

Abstract

Despite the risks of HIV transmission via breastfeeding, it is utilized worldwide for infant nutrition, especially in resource poor countries [1]. Due to limited resources, many mothers are not receiving antiretroviral therapy for their own disease, hence, the need for interventions during the peri- and postpartum period to prevent mother-to-child transmission. One strategy to limit transmission is providing antiretroviral agents to mothers of breastfeeding infants or antiretrovirals directly to the infants during the postpartum period while breastfeeding [1]. Both strategies have been shown to be effective at decreasing transmission rates [1–14]. This chapter focuses on the pharmacology of antiretrovirals in breast milk, while being administered to mothers, and the resultant exposure to the breastfeeding infant.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. UNICEF: Child Info: Monitoring the situation of children and women. lhttp://www.childinfo.org/breastfeeding_challenge.html. Accessed 17 May 2011

  2. Mofenson L (2010) Antiretroviral drugs to prevent breastfeeding HIV transmission. Antivir Ther 15:537–553

    Article  PubMed  Google Scholar 

  3. Chasela CS, Hudgens MG, Jaimeson DJ, Kayira D, Hosseinipour M, Kourtis AP et al (2010) Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. N Engl J Med 362:2271–2281

    Article  PubMed  CAS  Google Scholar 

  4. The Kesho Bora Study Group (2011) Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomized controlled trial. Lancet Infect Dis 11:171–180

    Article  Google Scholar 

  5. Kilewo C, Karlsson K, Massawe A, Lyamaya E, Swai A, Mhalu F et al (2008) Prevention of mother-to-child transmission of HIV-1 through breastfeeding by treating infants prophylactically with lamivudine in Dar es Salaam, Tanzania: the Mitra Study. J Acquir Immune Defic Syndr 48:315–323

    Article  PubMed  CAS  Google Scholar 

  6. Kilewo C, Karlsson K, Ngarina M, Massawe A, Lyamuya E, Swai A et al (2009) Prevention of mother-to-child transmission of HIV-1 through breastfeeding by treating mothers with triple antiretroviral therapy in Dar es Salaam, Tanzania: the MITRA PLUS Study. J Acquir Immune Defic Syndr 52:406–416

    Article  PubMed  Google Scholar 

  7. Kumwenda NI, Hoover DR, Mofenson LM, Thigpen MC, Kafulafula G, Li Q et al (2008) Extended antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med 359:119–129

    Article  PubMed  CAS  Google Scholar 

  8. Marazzi CM, Germano P, Liotta G, Guidotti G, Loureiro S, Gomes AC et al (2007) Implementing antiretroviral triple therapy to prevent HIV mother-to-child transmission: a public health approach in resource-limited settings. Eur J Pediatr 166:1305–1307

    Article  PubMed  Google Scholar 

  9. Palombi L, Marazzi MC, Voetberg A, Magid NA (2007) Treatment acceleration program and the experience of the DREAM program in prevention of mother-to-child transmission of HIV. AIDS 21(suppl 4):S65–S71

    Article  PubMed  Google Scholar 

  10. Peltier CA, Ndayisaba GF, Lepage P, van Griensven J, Leroy V, Pharm CO et al (2009) Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother to child infection in Rwanda. AIDS 23:2415–2423

    Article  PubMed  Google Scholar 

  11. Shapiro R, Hughes M, Ogwe A, Kitch D, Lockman S, Moffat C et al (2010) Antiretroviral regimens in pregnancy and breastfeeding in Botswana. N Engl J Med 362:2282–2294

    Article  PubMed  CAS  Google Scholar 

  12. Six Week Extended-Dose Nevirapine (SWEN) Study Team (2008) Extended-dose nevirapine to 6 weeks of age for infants to prevent HIV transmission via breastfeeding in Ethiopia, India, and Uganda: an analysis of three randomized controlled trials. Lancet 372:300–313

    Article  Google Scholar 

  13. Thior I, Lockman S, Smeaton LM, Shapiro RL, Wester C, Heymann SJ et al (2006) Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study. JAMA 296:794–805

    Article  PubMed  CAS  Google Scholar 

  14. Thomas TK, Masaba R, Borkowf CB, Ndivo R, Zeh C, Misore A, et al. Triple-antiretroviral prophylaxis to prevent mother-to-child HIV transmission through breastfeeding – the Kisumu Breastfeeding Study, Kenya: a clinical trial. PLoS Med 2011 Mar;8(3):e1001015. Epub 2011 Mar 29

    Google Scholar 

  15. Vyankandondera J, Luchters S, Hassink E, Pakker N, Mmiro F, Okong P et al SIMBA-stopping infection from mother to child via breastfeeding in Africa. 3rd international AIDS society conference on HIV pathogenesis. 24–27 July 2003, Paris, France. [Abstract LB07]

    Google Scholar 

  16. Begg E, Duffull S, Hackett L, Ilett KF (2002) Studying drugs in human milk: time to unify the approach. J Hum Lact 18:323–343

    Article  PubMed  Google Scholar 

  17. Anderson G (2006) Using pharmacokinetics to predict the effects of pregnancy and maternal-infant transfer of drugs during lactation. Expert Opin Drug Metab Toxicol 2:947–960

    Article  PubMed  CAS  Google Scholar 

  18. Dean M, Stock B, Patterson RJ, Levy G (1980) Serum protein binding of drugs during and after pregnancy in humans. Clin Pharmacol Ther 28:253–261

    Article  PubMed  CAS  Google Scholar 

  19. Tomson T, Lindbom U, Ekqvist B, Sundqvist A (1994) Epilepsy and pregnancy: a prospective study of seizure control in relation to free and total plasma concentrations of carbamazepine and phenytoin. Epilepsia 35:122–130

    Article  PubMed  CAS  Google Scholar 

  20. Yerby MS, Friel PN, McCormick K, Koerner M, van Allen M, Leavitt AM et al (1990) Pharmacokinetics of anticonvulsants in pregnancy: alterations in plasma protein binding. Epilepsy Res 5:223–228

    Article  PubMed  CAS  Google Scholar 

  21. Best BM, Stek AM, Mirochnick M, Hu C, Li H, Burchett SK et al (2010) Lopinavir tablet pharmacokinetics with an increased dose during pregnancy. J Acquir Immune Syndr 54:381–388

    CAS  Google Scholar 

  22. Patterson KB, Dumond JB, Prince HA, Jenkins A, Scarsci K, Wang R et al Pharmacokinetics of the lopinavir/ritonavir tablet in HIV-infected pregnant women: a longitudinal investigation of protein bound and unbound drug exposure with empiric dosage adjustment. 18th conference on retroviruses and opportunistic infections, Feb 2011, Boston, MA

    Google Scholar 

  23. Larsen LA, Ito S, Koren G (2003) Prediction of milk/plasma concentration ratio of drugs. Ann Pharmacother 37:1299–1306

    Article  PubMed  CAS  Google Scholar 

  24. Atkinson HC, Begg EJ (1990) Prediction of drug distribution into human milk from physiochemical characteristics. Clin Pharmacokinet 18:151–167

    Article  PubMed  CAS  Google Scholar 

  25. Notarianni LJ, Belk D, Aird SA, Bennett PN (1995) An in vitro technique for the rapid determination of drug entry into breast milk. Br J Clin Pharmacol 40:333–337

    Article  PubMed  CAS  Google Scholar 

  26. Riant P, Urien S, Albengres E, Duche JC, Tillement JP (1986) High plasma protein binding as a parameter in the selection of betablockers for lactating women. Biochem Pharmacol 35:4579–4581

    Article  PubMed  CAS  Google Scholar 

  27. da Costa TH, Haisma H, Wells JC, Mander AP, Whitehead RG, Bluck LJ (2010) How much human milk do infants consume? Data from 12 countries using a standardized stable isotope methodology. J Nutr 140:2227–2232

    Article  PubMed  Google Scholar 

  28. Powe CE, Puopolo KM, Newburg DS, Lonnerdal B, Chen C, Allen M et al (2011) Effects of recombinant human prolactin on breast milk composition. Pediatrics 127:e359–e366

    Article  PubMed  Google Scholar 

  29. Rossi DT, Wright DS (1997) Analytical considerations for trace determinations of drugs in breast milk. J Pharm Biomed Anal 15:495–504

    Article  PubMed  CAS  Google Scholar 

  30. Rezk N, White N, Bridges A, Abdel-Megeed MF, Mohamed TM, Moselhy SS et al (2008) Studies on antiretroviral drug concentrations in breast milk: validation of a liquid chromatography-tandem mass spectrometric method for determination of 7 anti-human immunodeficiency virus medications. Ther Drug Monit 30:611–619

    Article  PubMed  CAS  Google Scholar 

  31. Bulterys M, Weidle PJ, Abrams EJ, Fowler MG (2005) Combination antiretroviral therapy in African nursing mothers and drug exposure in their infants: new pharmacokinetic and virologic findings. J Infect Dis 192:709–712

    Article  PubMed  CAS  Google Scholar 

  32. Colebunders R, Hodossy B, Burger D, Daems T, Roelens K, Coppens M et al (2005) The effect of highly active antiretroviral treatment on viral load and antiretroviral drug levels in breast milk. AIDS 19:1912–1914

    Article  PubMed  CAS  Google Scholar 

  33. Corbett A, Martinson F, Rezk N, Kashuba A, Jamieson D, Chasela C et al Antiretroviral drug concentrations in breast milk and breastfeeding infants. 15th conference on retroviruses and opportunistic infections, Feb 2008, Boston, MA [Poster 648]

    Google Scholar 

  34. Corbett A, Chasela C, Martinson F, Rezk N, Kashuba A, Jamieson D et al Lopinavir/ritonavir concentrations in breast milk and breastfeeding infants: the BAN study. 16th Conference on retroviruses and opportunistic infections, Feb 2009, Montreal, Canada [Poster T-139]

    Google Scholar 

  35. Corbett A, Kayira D, Kashuba A, White N, Kourtis A, Chasela C et al Pharmacokinetics (PK) of HAART in Mothers and Breastfeeding infants from 6–24 wks post partum. 51st interscience conference on antimicrobial agents and chemotherapy, Sep 2010, Boston, MA. [Poster A1-2017]

    Google Scholar 

  36. Mirochnick M, Thomas T, Capparelli E, Zeh C, Holland D, Masaba R et al (2009) Antiretroviral concentrations in breast-feeding infants of mothers receiving highly active antiretroviral therapy. Antimicrob Agents Chemother 53:1170–1176

    Article  PubMed  CAS  Google Scholar 

  37. Schneider S, Peltier A, Gras A, Arendt V, Karasi-Omes C, Mujawamariwa A et al (2008) Efavirenz in human breast milk, mothers’, and newborns’ plasma. J Acquir Immune Defic Syndr 48:450–454

    Article  PubMed  CAS  Google Scholar 

  38. Shapiro R, Holland D, Capparelli E, Lockman S, Thior I, Wester C et al (2005) Antiretroviral concentrations in breast-feeding infants of women in Botswana receiving antiretroviral treatment. J Infect Dis 192:720–727

    Article  PubMed  CAS  Google Scholar 

  39. Spencer L, Neely M, Mordwinkin N, Leon T, Fredericks T, Karim R et al Intensive pharmacokinetics of zidovudine, lamivudine and atazanavir and HIV-1 viral load in breast milk and plasma of HIV  +  women receiving HAART. 16th conference on retroviruses and opportunistic infections, Feb 2009, Montreal, Canada

    Google Scholar 

  40. Salazar-Gonzalez JF, Salazar MG, Learn GH, Fouda GG, Kang HH, Mahlokozera T et al (2011) Origin and evolution of HIV-1 in breast milk determined by single-genome amplification and sequencing. J Virol 85:2751–2763

    Article  PubMed  CAS  Google Scholar 

  41. Bennetto-Hood C, Aldrovandi G, King J, Woodman K, Ashouri N, Acosta EP (2007) Persistence of nevirapine in breast milk after discontinuation of treatment. Clin Infect Dis 45:391–394

    Article  PubMed  CAS  Google Scholar 

  42. Hudelson SE, McConnell MS, Bagenda D, Piwowar-Manning E, Parsons TL, Nolan ML et al (2010) Emergence and persistence of nevirapine resistance in breast milk after single-dose nevirapine administration. AIDS 24:557–561

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The University of North Carolina Eshelman School of Pharmacy, 3202 Kerr Hall; CB# 7569, Chapel Hill, NC, 27599, USA

    Amanda H. Corbett Pharm.D., B.C.P.S., F.C.C.P., AAHIVE

  2. The University of North Carolina Center for AIDS Research, 3202 Kerr Hall; CB# 7569, Chapel Hill, NC, 27599, USA

    Amanda H. Corbett Pharm.D., B.C.P.S., F.C.C.P., AAHIVE

Authors
  1. Amanda H. Corbett Pharm.D., B.C.P.S., F.C.C.P., AAHIVE
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amanda H. Corbett Pharm.D., B.C.P.S., F.C.C.P., AAHIVE .

Editor information

Editors and Affiliations

  1. School of Medicine, Emory University, Buford Highway 4770, Atlanta, 30341, Georgia, USA

    Athena P. Kourtis

  2. and Prevention, Global AIDS Program - China, Centers for Disease Control, Emory University School of Medicine, Beijing, 100600, China, People's Republic

    Marc Bulterys

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media New York

About this chapter

Cite this chapter

Corbett, A.H. (2012). Antiretroviral Pharmacology in Breast Milk. In: Kourtis, A., Bulterys, M. (eds) Human Immunodeficiency Virus type 1 (HIV-1) and Breastfeeding. Advances in Experimental Medicine and Biology, vol 743. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2251-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-2251-8_8

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-2250-1

  • Online ISBN: 978-1-4614-2251-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation