EP334 - MATERNAL ART IN BREASTFED HIV-EXPOSED, UNINFECTED CHILDREN – ANY ADVERSE EFFECTS? (ID 1333)
Abstract
Backgrounds:
Adherence to anti-retroviral therapy (ART) and negative maternal HIV viral load successfully prevent intrauterine and perinatal HIV infection in children. Yet, data on adverse effects in HIV exposed, uninfected children postnatally exposed to ART through breast milk, especially integrase inhibitors (INI), are lacking.
Methods
Seven HIV-exposed, uninfected children who were breastfed by their mothers were prospectively followed-up. The mothers‘ ART contained either abacavir/lamivudine (N=2) or tenofovir/emtricitabine (N=5) in combination with rilpivirin (N=3), dolutegravir (N=2), darunavir/r (N=1) or nevirapine (n=1). Infants and mothers were followed closely while breastfed by sequentially performing HIV-PCR, full blood count and serum levels of ART in infants. ART concentration in breast milk was measured when samples were available.
Results:
ART concentrations in breast milk and infants were highly heterogeneous, showing supratherapeutic levels of rilpivirin and dolutegravir in some infants, while darunavir/r and nevirapin never reached therapeutic levels. No elevation of liver enzymes or creatinine was observed. Full blood counts were compared with HIV-exposed formula-fed infants from 2012-2020 (N=62). No differences in hemoglobin levels and thrombocyte counts were observed. Neutrophil counts dropped in all infants irrespective of feeding mode around four months of age. At this age, 33% of breastfed infants had neutrophil < 1.000/µl, compared to 15% of formula-fed infants. No HIV infections were observed in both groups.
Conclusions/Learning Points:
Breastfeeding of HIV-exposed, uninfected children is feasible when ART adherence is high and viral load in mothers remains negative. No differences in liver enzymes or hemoglobin levels were observed in breastmilk as compared to formula fed infants. Neutrophil counts dropped in all infants around four months of age, with slightly lower values in the breastmilk group.
