Last update March 21, 2020
Very Low Risk
Nucleoside and nucleotide analog reverse-transcriptase inhibitors (NRTI) (Ribera 2011).
It is excreted in breast milk in small quantities (Mugwanya 2016, Benaboud 2011), much lower (200 times less) than the dose used in newborns and infants (Mugwanya 2016). The dosage in infants older than 3 months is 6 mg/kg/day and half from birth to that age (Ribera 2011).
No problems have been observed in infants whose mothers were taking it, except for mild diarrhea in 4% of cases (Mugwanya 2016), so its use in breastfeeding mothers is considered safe for both HIV treatment and pre-exposure prophylaxis (Mugwanya 2017, Seidman 2017).
The WHO recommends the so-called B+ option (highly active antiretroviral therapy - HAART) for all pregnant or breastfeeding women diagnosed with HIV, irrespective of their clinical status and CD4 count, continuing during breastfeeding and without interruption for life. Breastfeeding should be exclusive for 6 months and continue for 12 to 24 months along with complementary feeding (WHO 2016).
The recommended HAART combination is:
- Tenofovir + Lamivudine (or Emtricitabine) + Efavirenz daily.
Alternative first-line regimens are:
- Zidovudine + Lamivudine + Efavirenz (o Nevirapine)
- Tenofovir + Lamivudine (o Emtricitabine) + Nevirapine
The infant, irrespective of the type of breastfeeding, should take Nevirapine or Zidovudine daily for 6 weeks (WHO 2016).
Most countries in the world have adopted these recommendations which date from 2013 (Nelson 2014).
We do not have alternatives for Emtricitabine (FTC) since it is relatively safe.
Suggestions made at e-lactancia are done by APILAM team, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it.
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