Cabotegravir and Breastfeeding

Summary of use during lactation

A pharmacokinetic analysis found low levels of cabotegravir in breastmilk with maternal use of long-acting cabotegravir. Maintaining viral suppression with antiretroviral therapy decreases breastfeeding transmission risk to less than 1%, but not zero. Individuals with HIV who are on antiretroviral therapy with a sustained undetectable viral load and who choose to breastfeed should be supported in this decision. If a viral load is not suppressed, banked pasteurized donor milk or formula is recommended.[1,2] Extended postnatal prophylaxis of breastfed infants with cabotegravir should continue until breastfeeding is stopped.[3]

Drug levels in milk and infant serum

Maternal Levels. An abstract reports a study in which long-acting cabotegravir 600 mg was injected intramuscularly every 56 days to 27 nursing mothers. Median breastmilk concentrations at these times were 14.6 mcg/L just before the 1-month injection, 29.8 mcg/L one week later, 27.4 mcg/L just before the 5-month injection, and 36.1 mcg/L one week later.[4] 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.

Effects on lactation and breastmilk

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

Alternative drugs to consider

Raltegravir

References

1. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: Recommendations for a public health approach. 2021 https://www.who.int/publications/i/item/9789240031593 PubMed
2. Department of Health and Human Services. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. 2024 https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/perinatal-hiv/guidelines-perinatal.pdf
3. Van de Perre P, Moles JP, Nagot N. HIV postnatal prophylaxis: How long is long enough? Expert Rev Anti Infect Ther 2025;23:1075–81.41216942 PubMed
4. Yoseph M, Momper J, Shava E, et al. Evaluating CAB-LA concentration and breastmilk transfer in postpartum PrEP: Results from the Tshireletso PK substudy. J Int AIDS Soc 2025;28:e26518 2025:e26518. doi:10.1002/jia2.26518