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Tenofivir and breastfeeding

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  • Tenofivir and breastfeeding

    I am a pediatrician and a mom-to-be. I am currently on Tenofivir for chronic hepatitis B. I'm 29 weeks and so far my pregnancy has been uncomplicated. As a pediatrician, I'm obviously pro-breastfeeding, but my gastroenterologist is recommending not breastfeeding while on the medication. Has there been any more research done to shed light on the effects of breastfeeding on the infant while on Tenofivir?

  • #2
    Hi, thanks for your post.

    We have a study in Rhesus monkeys and a small study of women with HIV to draw from. Both papers indicated that Tenofovir is excreted in the breastmilk in minute quantities. The authors estimated that an exclusively breastfeeding infant would be exposed to somewhere between 0.05-0.4% of the mother's daily dose. Furthermore, the conjugate salt (DISOPROXIL FUMARATE) that gives the drug its oral bioavailability is not present in the milk. Unconjugated Tenofovir is around 5% absorbed. In total, the levels in the infant plasma are very likely to be subclinical.

    Several chart review studies have concluded that breastfeeding does not raise the risk of vertical HBV transmission if the infant has been vaccinated within 24 hrs of birth.

    Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

    -James Abbey, MD and Thomas W. Hale, Ph.D.

    The following references may be useful if you need more information:

    K. Van Rompay, M. Hamilton, B. Kearney and N. Bischofberger, Pharmacokinetics of tenofovir in breast milk of lactating rhesus macaques. Antimicrob Agents Chemother 49, 2093-2094 (2005).

    Benaboud S, Pruvost A, Coffie PA, et al. Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan, Cote d'Ivoire, in the ANRS 12109 TEmAA Study, Step 2. Antimicrobial agents and chemotherapy. Mar 2011;55(3):1315-1317

    Beasley RP, Stevens CE, Shiao IS, Meng HC. Evidence against breast-feeding as a mechanism for vertical transmission of hepatitis B. Lancet 1975; 2(7938):740-741.

    Woo D, Cummins M, Davies PA, Harvey DR, Hurley R, Waterson AP. Vertical transmission of hepatitis B surface antigen in carrier mothers in two west London hospitals. Arch Dis Child 1979; 54(9):670-675.

    Hill JB, Sheffield JS, Kim MJ, Alexander JM, Sercely B, Wendel GD: Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Obstet Gynecol 2002, 99(6):1049-1052.

    Qiu L, Binns CW, Zhao Y, Zhang K, Xie X: Hepatitis B and breastfeeding in Hangzhou, Zhejiang Province, People's Republic of China. Breastfeed Med 2010, 5(3):109-112.

    Shi Z, Yang Y, Wang H, Ma L, Schreiber A, Li X, Sun W, Zhao X, Yang X, Zhang L et al: Breastfeeding of newborns by mothers carrying hepatitis B virus: a meta-analysis and systematic review. Arch Pediatr Adolesc Med 2011, 165(9):837-846.
    Last edited by admin-james; 10-09-2014, 08:20 AM. Reason: typo

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    • #3
      Thank you, Dr. Abbey and Dr. Hale for this very helpful response. I think I can feel less guilty now about choosing to breastfeed my baby!

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