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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Hair and plasma data show that lopinavir, ritonavir, and efavirenz all transfer from mother to infant in utero, but only efavirenz transfers via breastfeeding
Journal of Acquired Immune Deficiency Syndromes, Volume 63, No. 5, Year 2013
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Description
Background: As efforts intensify to eliminate perinatal HIV transmission, understanding kinetics of maternal-to-child transfer of antiretrovirals during pregnancy and breastfeeding is critical. Antiretroviral levels in plasma, cord blood, and breastmilk reflect exposure over short intervals. Hair concentrations reflect cumulative exposure and can uniquely quantify in utero transfer of maternal medications to infants. We measured plasma and hair antiretroviral levels in HIV-infected Ugandan mothers and their infants at delivery and during breastfeeding to assess transfer. Methods: HIV-infected pregnant women were randomized to lopinavir/ritonavir- or efavirenz-based therapy in a larger trial (the Prevention of Malaria and HIV disease in Tororo, PROMOTE). At 0, 8, and 12 weeks postpartum, plasma antiretroviral levels were measured in 117 mother-infant pairs; hair levels were assayed at 12 weeks. Ratios and correlations of infant:maternal concentrations were calculated. Results: By 12 weeks, 90.4% of mothers reported exclusive breastfeeding. Hair and plasma levels over time suggest moderate (47%) to extensive (87%) in utero transfer of lopinavir and ritonavir, respectively, but negligible transfer of either via breastfeeding. Moderate transfer of efavirenz occurs during pregnancy and breastfeeding (40% cumulative; 15% during breastfeeding). Despite differences in exposure, no infant seroconversions or correlations between infant hair/plasma antiretroviral levels and adverse effects were observed. Conclusions: Using a unique approach combining hair and plasma data, we found that different antiretrovirals have distinct kinetics of mother-to-infant transfer. Efavirenz transfers during both pregnancy and breastfeeding, whereas lopinavir and ritonavir transfer only in utero. Further study of the degree and timing of maternal-to-child transfer by antiretroviral will help optimize strategies that protect infants and minimize toxicities during periods of risk. Copyright © 2013 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Gandhi, Monica
United States, San Francisco
Ucsf School of Medicine
Mwesigwa, Julia
Uganda, Kampala
Makerere University College of Health Sciences
Aweeka, Francesca T.
United States, San Francisco
University of California, San Francisco
Plenty, Albert H.J.
United States, San Francisco
Ucsf Center for Aids Prevention Studies
Charlebois, Edwin D.
United States, San Francisco
Ucsf School of Medicine
United States, San Francisco
Ucsf Center for Aids Prevention Studies
Ruel, Theodore D.
United States, San Francisco
University of California, San Francisco
Huang, Yong
United States, San Francisco
University of California, San Francisco
Clark, Tamara D.
United States, San Francisco
Ucsf School of Medicine
Ades, Veronica
United States, San Francisco
University of California, San Francisco
Natureeba, Paul
Uganda, Kampala
Makerere University College of Health Sciences
Luwedde, Flavia Aliba
Uganda, Kampala
Makerere University College of Health Sciences
Achan, Jane
Uganda, Kampala
Makerere University College of Health Sciences
Kamya, Moses Robert K.
Uganda, Kampala
Makerere University College of Health Sciences
Havlir, Diane V.
United States, San Francisco
Ucsf School of Medicine
Cohan, Deborah L.
United States, San Francisco
University of California, San Francisco
Statistics
Citations: 55
Authors: 15
Affiliations: 4
Identifiers
Doi:
10.1097/QAI.0b013e31829c48ad
ISSN:
15254135
Research Areas
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Participants Gender
Female