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Triple ARV Prophylaxis Reduces Viral Load in Breast Milk

elivery, the women receiving ART had a median CD4 count of 551 cells/mm3 (range 183-1291) versus a median of 347 cells/mm3 (range 28-1091) in group B (p = <0.001). Statistical analysis determined correlations between plasma and breast milk HIV RNA levels and between drug levels and plasma/breast milk HIV RNA.

At delivery, the median plasma viral load in group A was 2.2 log versus 4.8 log in group B. In group A, the median viral load level in breast milk was higher than in plasma (2.3 vs. 2.2 respectively) and in group B, the opposite was true (3.4 vs. 4.8). At day seven the median HIV RNA level in breast milk in both groups was lower than in plasma and the median plasma viral load had increased by 0.1 log.

In group A, the median HIV RNA level in breast milk was 1.9 vs. 2.3 logs in plasma. In group B, the median HIV RNA level in breast milk was 3.6 log vs. 4.9 in plasma. The proportion of women with HIV RNA levels <400 copies/mL in both plasma and breast milk in group A was significantly lower at delivery (almost five times more likely) and at day 7 (12 times) than that found in group B, with an odds ratio of 4.8.

Looking only at women who had detectable viral load at delivery and day 7, the median concentrations of NVP, 3TC, and AZT were 0.6, 1.8, and 1.1 times higher in breast milk than in plasma. Individual drug level concentration of each of the three drugs was similar at both points in time.

Only in the median plasma NVP level at day seven was there an inverse correlation to HIV viral load and the authors suggest this might be attributable to the small sample size. At delivery, there was no significant correlation between NVP concentration and plasma/breast milk viral load and similarly, there was a lack of correlation between concentrations of AZT and 3TC and plasma/milk viral loads.

In 10% of cases, NVP drug concentration was detectable in breast milk, but not in plasma, indicating that NVP might be e
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