Objectives To evaluate antiretroviral drug concentrations in mothers and infants enrolled under the Option B-Plus approach for the prevention of HIV mother-to-child transmission in Malawi and to assess the maternal virological response after 1 year of treatment. Patients and methods Forty-seven women and 25 children were studied. Mothers were administered during pregnancy a combination of tenofovir, lamivudine and efavirenz and continued it during breastfeeding (up to 2 years) and thereafter. Drug concentrations were evaluated in mothers (plasma and breast milk) at 1 and 12 months post-partum and in infants (plasma) at 6 and 12 months of age. Drug concentrations were determined using an LC-MS/MS validated methodology. Results In breast milk, tenofovir concentrations were very low (breast milk/maternal plasma ratio = 0.08), while lamivudine was concentrated (breast milk/plasma ratio = 3) and efavirenz levels were 80% of those found in plasma. In infants, median levels at 6 months were 24 ng/mL tenofovir, 2.5 ng/mL lamivudine and 86.4 ng/mL efavirenz. At month 12, median levels were below the limit of quantification for the three drugs. No correlation was found between drug concentrations and laboratory parameters or indices of growth. HIV-RNA >1000 copies/mL was seen at month 1 in 15% of the women and at month 12 in 8.5%. Resistance was found in half of the women with detectable viral load. Conclusions Breastfeeding infants under Option B-Plus are exposed to low concentrations of antiretroviral drugs. With this strategy, mothers had a good virological response 1 year after delivery.

Palombi, L., Pirillo, M., Marchei, E., Jere, H., Sagno, J., Luhanga, R., et al. (2016). Concentrations of tenofovir, lamivudine and efavirenz in mothers and children enrolled under the Option B-Plus approach in Malawi. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 71(4), 1027-1030 [10.1093/jac/dkv435].

Concentrations of tenofovir, lamivudine and efavirenz in mothers and children enrolled under the Option B-Plus approach in Malawi

PALOMBI, LEONARDO;MANCINELLI, SANDRO;LIOTTA, GIUSEPPE;
2016-12

Abstract

Objectives To evaluate antiretroviral drug concentrations in mothers and infants enrolled under the Option B-Plus approach for the prevention of HIV mother-to-child transmission in Malawi and to assess the maternal virological response after 1 year of treatment. Patients and methods Forty-seven women and 25 children were studied. Mothers were administered during pregnancy a combination of tenofovir, lamivudine and efavirenz and continued it during breastfeeding (up to 2 years) and thereafter. Drug concentrations were evaluated in mothers (plasma and breast milk) at 1 and 12 months post-partum and in infants (plasma) at 6 and 12 months of age. Drug concentrations were determined using an LC-MS/MS validated methodology. Results In breast milk, tenofovir concentrations were very low (breast milk/maternal plasma ratio = 0.08), while lamivudine was concentrated (breast milk/plasma ratio = 3) and efavirenz levels were 80% of those found in plasma. In infants, median levels at 6 months were 24 ng/mL tenofovir, 2.5 ng/mL lamivudine and 86.4 ng/mL efavirenz. At month 12, median levels were below the limit of quantification for the three drugs. No correlation was found between drug concentrations and laboratory parameters or indices of growth. HIV-RNA >1000 copies/mL was seen at month 1 in 15% of the women and at month 12 in 8.5%. Resistance was found in half of the women with detectable viral load. Conclusions Breastfeeding infants under Option B-Plus are exposed to low concentrations of antiretroviral drugs. With this strategy, mothers had a good virological response 1 year after delivery.
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/42 - Igiene Generale e Applicata
Settore MED/09 - Medicina Interna
Settore MED/17 - Malattie Infettive
English
Con Impact Factor ISI
efavirenz breast feeding child infant lamivudine malawi milk, human mothers plasma virology tenofovir anti-retroviral agents drug concentration
https://academic.oup.com/jac/article/71/4/1027/2363994#37762658
https://academic.oup.com/jac/article/71/4/1027/2363994
Palombi, L., Pirillo, M., Marchei, E., Jere, H., Sagno, J., Luhanga, R., et al. (2016). Concentrations of tenofovir, lamivudine and efavirenz in mothers and children enrolled under the Option B-Plus approach in Malawi. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 71(4), 1027-1030 [10.1093/jac/dkv435].
Palombi, L; Pirillo, M; Marchei, E; Jere, H; Sagno, J; Luhanga, R; Floridia, M; Andreotti, M; Galluzzo, C; Pichini, S; Mwenda, R; Mancinelli, S; Marazzi, M; Vella, S; Liotta, G; Giuliano, M
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2108/192282
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