This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mirochnick, M.
Right arrow Articles by Thigpen, M. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Mirochnick, M.
Right arrow Articles by Thigpen, M. C.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, March 2009, p. 1170-1176, Vol. 53, No. 3
0066-4804/09/$08.00+0     doi:10.1128/AAC.01117-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Antiretroviral Concentrations in Breast-Feeding Infants of Mothers Receiving Highly Active Antiretroviral Therapy{triangledown}

Mark Mirochnick,1* Timothy Thomas,2 Edmund Capparelli,3 Clement Zeh,2 Diane Holland,3 Rose Masaba,2 Prisca Odhiambo,2 Mary Glenn Fowler,4 Paul J. Weidle,5 and Michael C. Thigpen5

Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts,1 Centers for Disease Control and Prevention/Kenya Medical Research Institute, Kisumu, Kenya,2 University of California, San Diego Pediatric Pharmacology Research Unit, 4094 4th Avenue, Room 201, San Diego, CA 92103-0979,3 Makerere University-Johns Hopkins University Research Collaboration, P.O. Box 23491,Kampala, Uganda,4 Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Mailstop E-45, 1600 Clifton Road, Atlanta, Georgia 303335

Received 20 August 2008/ Returned for modification 24 November 2008/ Accepted 17 December 2008

There are limited data describing the concentrations of zidovudine, lamivudine, and nevirapine in nursing infants as a result of transfer via breast milk. The Kisumu Breastfeeding Study is a phase IIb open-label trial of prenatal, intrapartum, and postpartum maternal treatment with zidovudine, lamivudine, and nevirapine from 34 weeks of gestation to 6 months postpartum. In a pharmacokinetic substudy, maternal plasma, breast milk, and infant dried blood spots were collected for drug assay on the day of delivery and at 2, 6, 14, and 24 weeks after delivery. Sixty-seven mother-infant pairs were enrolled. The median concentrations in breast milk of zidovudine, lamivudine, and nevirapine during the study period were 14 ng/ml, 1,214 ng/ml, and 4,546 ng/ml, respectively. Zidovudine was not detectable in any infant plasma samples obtained after the day of delivery, while the median concentrations in infant plasma samples from postpartum weeks 2, 6, and 14 were 67 ng/ml, 32 ng/ml, and 24 ng/ml for lamivudine and 987 ng/ml, 1,032 ng/ml, and 734 ng/ml for nevirapine, respectively. Therefore, lamivudine and nevirapine, but not zidovudine, are transferred to infants via breast milk in biologically significant concentrations. The extent and effect of infant drug exposure via breast milk must be well understood in order to evaluate the benefits and risks of maternal antiretroviral use during lactation.

* Corresponding author. Mailing address: Boston Medical Center, 850 Harrison Avenue, Yawkey 2N-06, Boston, MA 02118. Phone: (617) 414-3754. Fax: (617) 414-7297. E-mail: markm{at}bu.edu

{triangledown} Published ahead of print on 29 December 2008.

Antimicrobial Agents and Chemotherapy, March 2009, p. 1170-1176, Vol. 53, No. 3
0066-4804/09/$08.00+0     doi:10.1128/AAC.01117-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»