In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, exclusive breastfeeding for 6 months is recommended for HIV-infected mothers to reduce the risk of HIV transmission from the mother to the infant compared with mixed feeding. In these settings, abrupt weaning at 4 months does not reduce the risk of HIV transmission or produce an overall health benefit compared to continued breastfeeding, and increases the risk of infant death in HIV-infected infants. Extended antiretroviral prophylaxis in breastfed infants with antiretroviral drugs appears to reduce the rate of HIV transmission during breastfeeding by about half, but the optimal regimen and duration of prophylaxis has not yet been defined. Limited published experience with tenofovir during breastfeeding in HIV-positive mothers and HIV negative mothers treated for hepatitis B infection indicates that the exposure of the infant to the drug is trivial and unlikely to have any adverse consequences.
Tenofovirhas not been studied in HIV-negative nursing mothers being treated for hepatitis B infection, but the low doses used would not be expected to cause any serious adverse effects in breastfed infants. Some sources recommend not breastfeeding during lamivudine therapy for hepatitis B. In a survey, 226 physicians with a practice interest in liver disease in the United States responded. Of these, 31% stated that they recommend breastfeeding for their patients with hepatitis B who are taking antiviral therapy, 44% stated that they do not recommend breastfeeding during antiviral therapy and 25% stated that they were unsure.
Five exclusively breastfeeding mothers received oral tenofovir 300 mg plusemtricitabine200 mg and nevirapine 200 mg at the start of labor, then oral tenofovir 300 mg daily andemtricitabine200 mg for 7 days postpartum. A total of 16 concurrent maternal blood and milk samples were collected on days 1, 2, 3, and 7 postpartum between 10 minutes and 21 hours after the mothers' doses. Median peak and trough tenofovir concentrations in breastmilk were 14.1 mcg/L and 6.8 mcg/L, respectively. The authors estimated that an exclusively breastfed infant would receive about 0.03% of the proposed infant dose for tenofovir and achieve trivial infant serum concentrations that would likely have no adverse consequences.
Five infants were exclusively breastfed by 4 mothers who took tenofovir 245 mg (presumably 300 mg oftenofovirdisoproxilfumarate) daily. At an average of 1.8 months of age, infant serum tenofovir concentrations were measured.Tenofovirwas undetectable (<0.005 mg/L) in the serum of 4 of the infants, and 0.0055 mg/L in the serum of one infant.
Effects in Breastfed Infants:
Five women with hepatitis B infection were treated withtenofovirdisoproxilfumarate300 mg daily beginning in the third trimester of pregnancy and continuing postpartum. Although instructed not to breastfeed, 5 mothers breastfed (extent not stated) their newborn infants and no short-term adverse reactions were seen.
Two newborn infants whose mothers were treated with tenofovir 245 mg (presumably 300 mg oftenofovirdisoproxilfumarate) daily were exclusively breastfed for 3 months. At 4 months of age, neither showed any adverse outcomes on standard developmental parameters.
Possible Effects on Lactation:
Relevant published information was not found as of the revision date.
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