Malnutrition may reduce levels of human immunodeficiency virus (HIV) medications in pregnant or breastfeeding women, which may hamper efforts to prevent mother-to-child transmission, according to a study published today in the The Journal of Clinical Pharmacology.
Maternal infections with HIV in sub-Saharan Africa present a pressing public health concern, with as many as 40% of pregnant women infected, according to the study authors. Antiretroviral treatment during pregnancy and breastfeeding can substantially reduce the risk that these mothers will pass the virus to their newborns, so many governments and aid organizations have emphasized maternal treatment as a way to curb transmission. The new findings bolster previous evidence demonstrating the importance of addressing malnutrition simultaneously with drug treatment.
Imke H. Bartelink, PharmD, of the University of California, San Francisco, and colleagues from the United States and Uganda found that malnutrition may complicate efforts to reduce mother-to-child transmission through antiretroviral treatment. The study involved 225 Ugandan women who were being treated for HIV infection. Many were malnourished; 80% reported lacking adequate food for their families, 50% reported moderate to severe hunger, and 26% lost weight during pregnancy.
The researchers analyzed blood spots and hair samples from the women for lopinavir, ritonavir, and efavirenz levels. They found that drug levels were substantially reduced in malnourished study participants compared with well-nourished participants, with a decrease in exposure of 33% for lopinavir, 15% for efavirenz, and 17% for ritonavir. As expected, they also found that during pregnancy the body clears lopinavir and ritonavir more quickly, something that clinicians account for when dosing pregnant women.
Previous studies also have suggested that malnutrition may reduce the likelihood that patients taking antiretroviral medication will take them as prescribed, without skipping doses. Bartelink and colleagues used the samples as a means to verify whether the adherence rates that patients reported were accurate, and confirmed that such testing can be a useful tool in helping to verify adherence.