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      Cabergoline: a review of its use in the inhibition of lactation for women living with HIV

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          Abstract

          Introduction

          In developed countries, breastfeeding is not recommended for women living with human immunodeficiency virus (WLWH). However, lactation symptoms can be distressing for women who choose not to breastfeed. There is currently no universal guideline on the most appropriate options for prevention or reduction of lactation symptoms amongst WLWH. This review describes the evidence base for using cabergoline, a dopaminergic agonist, for the post‐partum inhibition of lactation for WLWH.

          Methods

          A scoping review of post‐partum pharmaceutical lactation inhibition specific for WLWH was conducted using searches in PubMed, Medline Ovid, EBM Reviews Ovid, Embase, Web of Science and Scopus until 2019. A narrative review of cabergoline pharmacologic properties, therapeutic efficacy, tolerability data and drug interaction data relevant to lactation inhibition was then conducted.

          Results and discussion

          Among 1366 articles, the scoping review identified 13 relevant publications. Eight guidelines providing guidance regarding lactation inhibition for WLWH and two surveys of medical practice on this topic in UK have been published. Three studies have evaluated the use of pharmaceutical agents in WLWH. Two of these studies evaluated cabergoline and reported it to be an effective method of lactation inhibition in this population. The third study evaluated ethinyl estradiol and bromocriptine use and showed poor efficacy. Cabergoline is a long‐acting dopamine D2 agonist and ergot derivative that inhibits prolactin secretion and suppresses physiologic lactation when given as a single oral dose of 1 mg after delivery. Cabergoline is at least as effective as bromocriptine for lactation inhibition with success rates between 78% and 100%. Transient, mild to moderate adverse events to cabergoline are described in clinical trials. Few drug interactions exist as cabergoline is neither a substrate nor an inducer/inhibitor of hepatic cytochrome P450 isoenzymes. There are no reported clinically significant drug–drug interactions between cabergoline and any antiretroviral medications including protease inhibitors.

          Conclusions

          Cabergoline is a safe and effective pharmacologic option for the prevention of physiological lactation and associated physical symptoms in non‐breastfeeding women. Future studies should focus on its safety, efficacy and acceptability among WLWH.

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          Most cited references41

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          Guidance for conducting systematic scoping reviews.

          Reviews of primary research are becoming more common as evidence-based practice gains recognition as the benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review types is the 'scoping review'. In general, scoping reviews are commonly used for 'reconnaissance' - to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommendations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five Joanna Briggs Collaborating Centres.
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            Risk of human immunodeficiency virus type 1 transmission through breastfeeding.

            Detection of human immunodeficiency virus type 1 (HIV-1) in breast milk by culture and polymerase chain reaction does not necessarily mean that breastfeeding is a route of transmission, although evidence from several case-reports points in that direction. We undertook a systematic review of published studies meeting criteria that allowed determination of quantitative risk of transmission via breastfeeding. Based on four studies in which mothers acquired HIV-1 postnatally, the estimated risk of transmission is 29% (95% Cl 16-42%). Analysis of five studies showed that when the mother was infected prenatally, the additional risk of transmission through breastfeeding, over and above transmission in utero or during delivery, is 14% (95% Cl 7-22%). Where there are safe alternatives to breastfeeding, universal named testing of pregnant women would provide an opportunity to advise more infected women not to breastfeed and might thereby reduce the number of vertically infected children. Since breastfeeding protects against infant deaths from infectious diseases, breastfeeding is still recommended where infectious diseases are a common cause of death in childhood, despite the additional risk of HIV transmission.
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              The complexities of antiretroviral drug-drug interactions: role of ABC and SLC transporters.

              Treatment of human immunodeficiency virus (HIV) infection involves a combination of several antiviral agents belonging to different pharmacological classes. This combination is referred to as highly active antiretroviral therapy (HAART). This treatment has proved to be very effective in suppressing HIV replication, but antiretroviral drugs have complex pharmacokinetic properties involving extensive drug metabolism and transport by membrane-associated drug carriers. Combination drug therapy often introduces complex drug-drug interactions that can result in toxic or sub-therapeutic drug concentrations, compromising treatment. This review focuses on the role of ATP-binding cassette (ABC) membrane-associated efflux transporters and solute carrier (SLC) uptake transporters in antiretroviral drug disposition, and identifies clinically important antiretroviral drug-drug interactions associated with changes in drug transport. 2009 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                isabelle.boucoiran@umontreal.ca
                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                10.1002/(ISSN)1758-2652
                JIA2
                Journal of the International AIDS Society
                John Wiley and Sons Inc. (Hoboken )
                1758-2652
                11 June 2019
                June 2019
                : 22
                : 6 ( doiID: 10.1002/jia2.2019.22.issue-6 )
                : e25322
                Affiliations
                [ 1 ] Department of Pharmacy BC Women's Hospital and Health Centre Vancouver BC Canada
                [ 2 ] Women's Health Research Institute Vancouver BC Canada
                [ 3 ] CHU Sainte‐Justine Montreal QC Canada
                [ 4 ] Department of Obstetrics and Gynaecology University of British Columbia Vancouver BC Canada
                [ 5 ] Department of Obstetrics and Gynecology CHU Sainte‐Justine Université de Montréal Montreal QC Canada
                Author notes
                [*] [* ] Corresponding author: Isabelle Boucoiran, CHU Sainte Justine, Department of Obstetrics and Gynecology, 3175 Côte Sainte‐Catherine, Montreal, Quebec, Canada H3T 1C5. Tel: 1‐514‐345‐4931 (#6909). ( isabelle.boucoiran@ 123456umontreal.ca )
                Author information
                https://orcid.org/0000-0001-9545-6024
                Article
                JIA225322
                10.1002/jia2.25322
                6558502
                31183987
                ee419dda-3829-4553-8044-2a152c526e78
                © 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 September 2018
                : 22 May 2019
                Page count
                Figures: 1, Tables: 2, Pages: 10, Words: 7174
                Funding
                Funded by: Canadian Foundation for AIDS Research
                Categories
                Review
                Reviews
                Custom metadata
                2.0
                jia225322
                June 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:11.06.2019

                Infectious disease & Microbiology
                cabergoline,lactation inhibition,lactation suppression,post‐partum,hiv

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