Pharmacodynamics impact of etravirine disposition into breast milk in relation to HIV replication in this milk

Mother‐to‐child transmission (MTCT) through breastfeeding continues to be a major concern for the transmission of HIV infection among children in developing countries. The transmission usually occurs in the early stage during breastfeeding, where the infant’s gastrointestinal integrity may be compromised. Highly antiretroviral therapy (HAART) plays an important role in the control of viral replication in the plasma of infected HIV patients. HIV positive women patients receiving HAART during pregnancy and postpartum has become a crucial strategy to suppress the viral load in breast milk in hope to prevent MTCT. However it is not known whether the level of ARV is adequate to prevent infant acquisition of HIV. Etravirine (ETR), a NNRTI, is a second generation NNRTI that has been approved as a second line treatment for HIV infection. It is active against several common HIV 1 mutants that are resistant to first generation NNRTIs. In this study, we used a 14-day intensive ETR included HAART on postpartum women subjects. The results indicated that the disposition of ETR in breast milk from plasma after the treatment and a relatively low ETR BM concentration in both viral detectable subjects. Also, the distinct selection of ARVs for HAART may affect ETR BM concentration. In summary, intensive ETR included HAART may be a potential effective measure to prevent MTCT in those resource‐limited areas.