AEGiS-14IAC: Impact of chloroquine on viral load in breast milk.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Impact of chloroquine on viral load in breast milk.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10213)

Semrau K, Kasonde P, Vwalika C, Ghosh M, Sinkala M, Kankasa C, Thea DM, Kuhn L, Aldrovandi G
University of Alabama, Department of Pediatrics, Birmingham, United States

BACKGROUND: Chloroquine (CQ) has in-vitro and in-vivo antiviral effect, and accumulates in mammary epithelial cells. Maternal CQ administration during breastfeeding may decrease milk viral load (VL), and therefore lower the risk of breastmilk (BM) associated mother-to-child transmission.

METHODS: The Zambia Exclusive Breastfeeding Study (ZEBS) is a randomized trial, which examines the impact of short exclusive breastfeeding on MTCT. BM samples are collected regularly through the breastfeeding period. As of 12/01, 7 lactating mothers who took CQ (600mg x 2d and 300 x 1 d) for a febrile illness presumptive of malaria infection, provided BM samples for analysis w/in 3-13 days (mean 8.2) of the start of the course. These were randomly matched (1:2) with controls by CD4 (±50) counts and scheduled visit date (e.g. 1 week). HIV RNA VL was determined (Amplicor 1.5) for left (LBM) and right (RBM) BM samples - expressed as log₁₀.

RESULTS: For the full sample, (n=21) mean (std dev) VL was 2.49 (0.73). LBM mean VL was 2.55 (0.66) and 2.42 (0.63) for RBM (r2=0.43). BM from mothers who took CQ (n=7) had a mean VL load of 2.88 (0.93), vs. 2.29 (0.55) in mothers not taking (NCQ) (n=14). A trend towards higher VL was seen in pooled BM samples from CQ women versus NCQ (p=0.13 by KW). Analysis stratified by breast (LBM vs. RBM) showed a similar trend: CQ group mean VL in LBM was 2.93 (0.79) and RBM was 2.82 (1.13), versus 2.36 (0.78) in LBM and 2.22 (0.51) in the RBM of NQC mothers. The trend of higher VL in CQ, by breast, remained; RBM (p=0.17 by KW) and LBM (p=0.13 by KW). Mean CD4 count was 380.

CONCLUSIONS: A trend towards higher VL was seen among women taking CQ in this sample. If substantiated with a larger sample, this result may be due to the acute-phase effects on VL of the underlying febrile illness among the women who took CQ. While limited by size and methodology, these results do not support the effect of CQ on decreasing VL in BM.

Keywords: AEGIS, Viral Load, Milk, Human, Chloroquine, Breast Feeding, CD4 Lymphocyte Count, HIV Infections, Mothers, HIV, Dietary Supplements, HIV Seropositivity, Case-Control Studies, Zambia, Human, Female, Child

020707
B10213