Therapeutic Drug Monitoring of antiretroviral Therapy in breast feeding women in Mali: Pilot study

Abstract

Objective: Mother-to-child transmission of HIV during breastfeeding is a public health problem. The aim of this study was to assess the value of pharmacological therapeutic monitoring of breastfeeding women on ARVs and their children in Bamako.

Methods: Patients were recruited from September 1, 2015 to September 30, 2016 following informed consent. Mothers and their -children were followed in the pediatric department of CHU Gabriel Touré. Plasma viral loads were performed at the UCRC in Bamako. Plasma drug concentrations were determined at the Pharmacokinetics laboratory in Toulouse. Data were entered and analyzed using SPSS version 20 software.

Results: The average age of the mothers was 29±75 years [19-41 years]. At D0, only one of the patients had a detectable plasma viral load, i.e. 3.33% (6610copies/ml), and 73.91% of the mothers had a CD4 count greater than 350 cells/mm3. After 6 months, 3 mothers had a detectable viral load (200copies/ml; 72copies/ml and 4777 copies/ml) and 86.36% of mothers had a CD4 count greater than 350 cells/mm3. Median maternal plasma concentrations of lopinavir and efavirenz at 3 months were 5770ng/ml; 3505ng/ml and 5850ng/ml; 3245ng/ml at 6 months, respectively.  All infants were PCR-negative at 3 and 6 months' follow-up.

Conclusion: The measurement of biological parameters is an essential link in the management of HIV-positive nursing mothers in Mali.