Hi Peter.
The concern with taking PEP while breastfeeding is more about the potential risk of secondary transmission if she were to acquire HIV and less about toxicity from the ARVs. ARVs have not been well studied in breast/chest feeding but there is some data. The components of Truvada pass into breast milk in very small quantities and are safe based on studies of PrEP and hepatitis B treatment. Dolutegravir passes into breast milk but also in much lower amounts than would be used for treatment. RAL secretion in human breast milk is largely unstudied. A single case study demonstrated low RAL transfer into breast milk and little accumulation. (All of this is from the DHHS perinatal guidelines.) The decision about whether or not to continue breastfeeding can be complicated and should be based on a lot of factors - how high risk was the exposure? What was the source person's viral load? How old is the baby and how do she and the baby feel about breastfeeding? Is the baby taking bottles? Is pumping and discarding for a month an option she wants to consider?
There's not really a one-size-fits-all straightforward answer but I hope that's helpful.
Best,
Lealah
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Lealah Pollock, MD MS
UCSF, National Clinician Consultation Center, Perinatal HIV Hotline
San Francisco CA
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Original Message:
Sent: 01-26-2023 16:53
From: Peter Shalit
Subject: Clinical conundrum
Health care provider has an accidental needlestick at work from a person with HIV. She is interested in PEP. She has an infant child who she is nursing. Does she need to stop nursing while on PEP or is there a PEP regimen she can take while nursing?
Peter Shalit, MD, PhD, FACP, AAHIVS