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Serum Phosphate and Creatinine Levels in the First Year of Life in Infants Born to HIV-Positive Mothers Receiving Tenofovir-Based Combination Regimens During Pregnancy and Prolonged Breastfeeding in an Option B+ Program in Malawi

INTRODUCTION After the recent WHO recommendations,1 several countries endorsed the initiation of lifelong ART, usually with a fixed combination of tenofovir, lamivudine and efavirenz, in all HIV-infected pregnant women, irrespective of CD4 count, with maintained infant breastfeeding up to 12 months (Option B+).2,3 Despite its widespread implementation, there is still incomplete information on the potential effects of the combined prenatal and postnatal (through breastfeeding) drug exposure on infant health. Particular attention is being paid to tenofovir, because the drug is known to have adverse effects on bone metabolism and renal function in adult HIV-infected patients,4–6 and it is important to exclude that infant exposure through transplacental passage and breastfeeding has adverse consequences.7–10 There is limited information on potential renal toxicity in the first year of life among infants enrolled in Option B+ programs, and no data are available with respect to hypophosphatemia, which represents a well-known component of the renal toxicity syndrome associated with tenofovir use.6 To further explore this issue, we investigated serum phosphate and creatinine levels in the first year of life in infants from mothers who received tenofovir, lamivudine, and efavirenz during pregnancy and 12 month of breastfeeding in a national Option B+ program in Sub-Saharan Africa.