（定期更新，新加母乳讨论）大三阳妈妈19周开始吃替诺，

喵小鱼儿

还有一篇
http://www.drugs.com/breastfeeding/tenofovir.html

大意是在新生儿中检测到的替诺含量很低，仅为提案的推荐新生儿用量的0。03% （此推荐药量还未正式批准，仅为提案中估计值），所以应该是安全的。     等我回头再来更新详细点的翻译。


Tenofovir Levels and Effects while Breastfeeding

Summary of Use during Lactation

In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, exclusive breastfeeding for 6 months is recommended for HIV-infected mothers to reduce the risk of HIV transmission from the mother to the infant compared with mixed feeding.[1][2][3][4][5][6] In these settings, abrupt weaning at 4 months does not reduce the risk of HIV transmission or produce an overall health benefit compared to continued breastfeeding, and increases the risk of infant death in HIV-infected infants.[7] Extended antiretroviral prophylaxis in breastfed infants with antiretroviral drugs appears to reduce the rate of HIV transmission during breastfeeding by about half, but the optimal regimen and duration of prophylaxis has not yet been defined.[8][9][10][11] Limited published experience with tenofovir during breastfeeding in HIV-positive mothers indicates that the exposure of the infant to the drug is trivial and unlikely to have any adverse consequences.

Tenofovir has not been studied in HIV-negative nursing mothers being treated for hepatitis B infection. In a survey, 226 physicians with a practice interest in liver disease in the United States responded. Of these, 31% stated that they recommend breastfeeding for their patients with hepatitis B who are taking antiviral therapy, 44% stated that they do not recommend breastfeeding during antiviral therapy and 25% stated that they were unsure.[12]

Drug Levels

Maternal Levels. Five exclusively breastfeeding mothers received oral tenofovir 300 mg plus emtricitabine 200 mg and nevirapine 200 mg at the start of labor, then oral tenofovir 300 mg daily and emtricitabine 200 mg for 7 days postpartum. A total of 16 concurrent maternal blood and milk samples were collected on days 1, 2, 3, and 7 postpartum between 10 minutes and 21 hours after the mothers' doses. Median peak and trough tenofovir concentrations in breastmilk were 14.1 mcg/L and 6.8 mcg/L, respectively. The authors estimated that an exclusively breastfed infant would receive about 0.03% of the proposed infant dose for tenofovir and achieve trivial infant serum concentrations that would likely have no adverse consequences.[13]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Possible Effects on Lactation

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

Lamivudine, Nelfinavir, Nevirapine, Zidovudine

References

1. World Health Organization. HIV and infant feeding: update. 2007. http://whqlibdoc.who.int/publications/2007/9789241595964_eng.pdf

2. Dao H, Mofenson LM, Ekpini R et al. International recommendations on antiretroviral drugs for treatment of HIV-infected women and prevention of mother-to-child HIV transmission in resource-limited settings: 2006 update. Am J Obstet Gynecol. 2007;197 (3 Suppl):S42-55. PMID: 17825650

3. Branson BM, Handsfield HH, Lampe MA et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55 (RR-14):1-17. PMID: 16988643

4. McIntyre J, Dabis F, Mofenson LM et al. Rapid advice: Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. World Health Organization. Geneva. 2009;1-23.

5. Chasela CS, Hudgens MG, Jamieson DJ et al. Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. N Engl J Med. 2010;362:2271-81. PMID: 20554982

6. Shapiro RL, Hughes MD, Ogwu A et al. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med. 2010;362:2282-94. PMID: 20554983

7. Kuhn L, Aldrovandi GM, Sinkala M et al. Effects of early, abrupt weaning on HIV-free survival of children in Zambia. N Engl J Med. 2008;359:130-41. PMID: 18525036

8. Kumwenda NI, Hoover DR, Mofenson LM et al. Extended antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med. 2008;359:119-29. PMID: 18525035

9. Mofenson LM. Antiretroviral prophylaxis to reduce breast milk transmission of HIV type 1: new data but still questions. J Acquir Immune Defic Syndr. 2008;48:237-40. PMID: 18545160

10. Bedri A, Gudetta B, Isehak A et al. Extended-dose nevirapine to 6 weeks of age for infants to prevent HIV transmission via breastfeeding in Ethiopia, India, and Uganda: an analysis of three randomised controlled trials. Lancet. 2008;372:300-13. PMID: 18657709

11. Chigwedere P, Seage GR, Lee TH, Essex M. Efficacy of antiretroviral drugs in reducing mother-to-child transmission of HIV in Africa: a meta-analysis of published clinical trials. AIDS Res Hum Retroviruses. 2008;24:827-37. PMID: 18544018

12. Ahn J, Salem SB, Cohen SM. Evaluation and management of hepatitis B in pregnancy: a survey of current practices. Gastroenterol Hepatol (N Y). 2010;6:570-8. PMID: 21088746

13. Benaboud S, Pruvost A, Coffie PA et al. Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan, Cote d'Ivoire, in the ANRS 12109 TEMAA Study, step 2. Antimicrob Agents Chemother. 2011;55:1315-7. PMID: 21173182

喵小鱼儿

还有一篇
先占地儿

喵小鱼儿

liver411 发表于 2012-8-31 14:17
理论上和大部分医生是不建议哺乳期间用核苷类似物药物抗病毒的，因为药物会出现在母乳中。但实际上，近 ...

你的文献资料基本和我看到的文献的观点一致，就是在母乳中的含量非常低，所以应该没有影响。目前还有一个比较大的替诺母乳研究项目正在进行，主要在非洲及其他地区，不过结果还没出来，那个出来就会有比较权威的正式结论了。

风风风风

回复 喵小鱼儿 的帖子

你会母乳吗 看起来是个好消息 。不知道什么时候出结果

雁过留声

喵小鱼儿 发表于 2012-9-2 15:10
你的文献资料基本和我看到的文献的观点一致，就是在母乳中的含量非常低，所以应该没有影响。目前还有一个 ...

期待。。。
希望是个好结论，这部分宝宝也能享受到母乳的权力。


明年最新一届美国指南不知会不会对这方面也有个定论？一起期待吧。

喵小鱼儿

风风风风 发表于 2012-9-4 10:38
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你会母乳吗 看起来是个好消息 。不知道什么时候出结果 ...

去见了医生。 我跟他讨论了大家所担心的肾毒性等问题，他的意见是 药的含量在母乳中非常少，不会有什么影响（话说回来这个副作用也只是极小部分人报告的症状，不是普遍的问题。我每次去见他的时候都验血，如果有什么问题的话也会反映在血检结果中。）而且母乳对宝宝的好处太大了。总之他非常坚持母乳，认为这根本不是个问题。他建议我如果还不放心的话，至少喂宝宝四个月，之后再作打算，比如可以母乳配方混搭。不过在他看来是没必要的，。

我自己后来想了想，怀孕的时候也是在吃这个药，羊水里也有的，对宝宝是安全的，难道生出来反而就不行啦？ 所以我的打算是，吃母乳（如果我有的话。。），然后一两个月左右去检查下宝宝，没问题的话就继续母乳。之后持续观察就行。这也和我看到的美国一个妈妈的做法大致相同： 她是母乳，一个月后带宝宝检查，各项指标都没问题。几个月之后她是一半母乳一半配方。我回头再去看一遍确认一下。她的宝宝已经快两岁了，很健康。


所以我已经决定了：母乳！

喵小鱼儿

最近刚查了血     结果在第一页更新了。ast alt 下降了 不错。

风风风风

回复 喵小鱼儿 的帖子

终于等到你的消息了，其实我也默默决定母乳了，虽然上海的肝科，产科，新生儿科都不同意我母乳，我还是要坚持，至少3个月吧，定期检查，保持联系 ~~  你有什么其他的方式吗 这个论坛经常上不了，我的预产期是10,15

爱可儿

mm你预产期什么时候呀，也是9月底吗？

爱可儿

我在想怎么保护乳头呢，很多人说喂奶初期会出血被孩子嘬的，如果出血了是不是就不太安全呢？