Hair and Plasma Data Show That Lopinavir, Ritonavir, and Efavirenz All Transfer From Mother to Infant In Utero, But Only Efavirenz Transfers via Breastfeeding
Hair and Plasma Data Show That Lopinavir, Ritonavir, and Efavirenz All Transfer From Mother to Infant In Utero, But Only Efavirenz Transfers via Breastfeeding
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DOI：
10.1097/qai.0b013e31829c48ad
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发表时间：
2013-08-15
影响因子：
3.6
通讯作者：
Cohan, Deborah
中科院分区：
文献类型：
--
作者：
Gandhi, Monica;Mwesigwa, Julia;Cohan, Deborah
背景资料：随着消除围产期艾滋病毒传播的努力的加强，了解怀孕和母乳喂养期间抗逆转录病毒药物母婴传播的动力学至关重要。血浆、脐带血和母乳中的抗逆转录病毒水平反映了短时间内的接触情况。毛发浓度反映了累积暴露量，可以唯一量化母体药物在子宫内转移给婴儿的情况。我们测量血浆和头发中的抗逆转录病毒水平在艾滋病毒感染的乌干达母亲和他们的婴儿在分娩和母乳喂养，以评估transfer.Methods：艾滋病毒感染的孕妇被随机洛匹那韦/利托那韦或依法韦仑为基础的治疗在一个更大的试验（预防疟疾和艾滋病毒疾病的托罗罗，PROMOTE）。在产后0，8，12周，血浆抗逆转录病毒水平进行了测量，在117对母婴;头发水平进行了分析，在12周。婴儿：产妇concentrations.Results的比率和相关性计算：由12周，90.4%的母亲报告纯母乳喂养。毛发和血浆水平随时间的变化分别表明洛匹那韦和利托那韦在子宫内的转移为中度（47%）至广泛（87%），但通过母乳喂养的转移可忽略不计。怀孕和母乳喂养期间发生依法韦仑的中度转移（累积40%;母乳喂养期间15%）。尽管暴露的差异，没有婴儿血清转换或婴儿头发/血浆抗逆转录病毒水平和不良反应之间的相关性observed.Conclusions：使用一种独特的方法相结合的头发和血浆数据，我们发现，不同的抗逆转录病毒药物有不同的动力学的母婴转移。依法韦仑在妊娠和哺乳期间转移，而洛匹那韦和利托那韦仅在子宫内转移。进一步研究抗逆转录病毒药物母婴传播的程度和时间，将有助于优化保护婴儿的战略，并在风险期间尽量减少毒性。
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.