Efavirenz (Sustiva) in Breast Milk and Blood Plasma of Mothers and Newborns

While antiretroviral monotherapy has been shown to dramatically reduce the risk of mother-to-child HIV transmission, use of a combination regimen has greater benefits for the woman's health and maximizes the chances of achieving an undetectable viral load.

Sustiva Tablet

HAART regimens containing efavirenz (Sustiva) have been prescribed to HIV positive pregnant women in Rwanda with CD4 cell counts above 350 cells/mm3 during the last trimester of pregnancy and for 6 months after delivery.

The current study, published in the August 1, 2008 Journal of Acquired Immune Deficiency Syndromes, reported on efavirenz concentrations in maternal blood plasma, breast milk, and newborns' plasma between 6 weeks and 6 months postpartum. The analysis included 13 women and their children.

Results

• The mean efavirenz concentration in maternal plasma was .55 mg/L.

• The mean concentration in breast milk was 3.51 mg/L.

• The mean plasma concentration in infants was 0.85 mg/L.

• Significant linear correlations were found between maternal plasma and breast milk (P < 0.0001), and between breast milk and infant plasma (P < 0.02).

• However, there was no significant correlation observed between maternal and infant plasma concentrations (P > 0.05).

The study authors reported that after 6 months of breast-feeding, none of the 13 children had been infected with HIV and "all had good psychomotor and growth development."

In conclusion, the authors wrote, "Our results suggest that efavirenz may be an alternative to nevirapine during the third trimester of pregnancy and during the breast-feeding period."

They added, "Further studies on larger groups of newborns will be necessary to get a better understanding of possible prophylactic protection of the newborns by highly active antiretroviral therapy [HAART] with efavirenz given to the mothers."

Laboratoire National de la Santé, Division de Toxicologie, Université du Luxembourg, Luxembourg; Centre Hospitalier Luxembourg, Service des Maladies Infectieuses, Luxembourg; Lux-Development, ESTHER Project Luxembourg, Kigali, Rwanda.

7/22/08

Reference

S Schneider, A Peltier, A Gras, and others. Efavirenz in human breast milk, mothers', and newborns' plasma. Journal of Acquired Immune Deficiency Syndromes 48(4): 450-454. August 1, 2008.

Related Articles

1. K Semrau, M Ghosh, C Kankasa, and others. Temporal and lateral dynamics of HIV shedding and elevated sodium in breast milk among HIV-positive mothers during the first 4 months of breast-feeding. Journal of Acquired Immune Deficiency Syndromes 47(3): 320-328. March 1, 2008.

2. K Lapphra, N Vanprapar, S Chearskul, and others. Efficacy and tolerability of nevirapine- versus efavirenz-containing regimens in HIV-infected Thai children. International Journal of Infectious Diseases. June 21, 2008 [Epub ahead of print].

3. J Volmink, NL Siegfried, L van der Merwe, and P Brocklehurst. Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database Systematic Review 24(1): CD003510. January 2007.

4. M Giuliano, G Guidotti, M Andreotti, and others. Triple antiretroviral prophylaxis administered during pregnancy and after delivery significantly reduces breast milk viral load: a study within the Drug Resource Enhancement against AIDS and Malnutrition Program. Journal of Acquired Immune Deficiency Syndromes 44(3): 286-291. March 1, 2007.

5. R Bequet, L Bequet, DK Ekouevi, and others (ANRS 1201/1202 Ditrame Plus Study Group). Two-year morbidity-mortality and alternatives to prolonged breast-feeding among children born to HIV-infected mothers in Côte d'Ivoire. PLoS Med 4(1): e17. January 2007.