Meet the CIPHER grantees

McNeil Ngongondo

Year awarded: 2016
Institution: The UNC Project, Malawi
Research site: Bwaila Hospital, Lilongwe, Malawi
Primary mentor: Mina Hosseinipour, UNC Project

McNeil Ngongondo is a medical doctor, a UJMT Fogarty Global Health Fellow and a data analysis intern with the MHIRST Program. His research interests are in ART use during pregnancy and breastfeeding and in implementation science.

More information on McNeil | Email

“For an upcoming researcher, the support from CIPHER has transformed my career by letting me do my own research and by opening up new opportunities.”

Research project: A pharmacokinetic evaluation of TDF and ATV exposure in HIV exposed breastfeeding infants of mothers taking TDF/3TC/ATV/r

The issue

Current WHO guidelines are that all people diagnosed with HIV, including pregnant and breastfeeding women, start lifelong ART. Women taking ART are encouraged to breastfeed for up to two years after birth during which the infants are exposed to ART via breast milk. The safety and long-term effects of exposure to ART in developing infants are unclear. When combined with a protease inhibitor, tenofovir (TDF) plasma levels are increased. This could mean greater infant exposure to TDF than when TDF is used in other regimens. The PROMISE study found an increased risk of infant mortality born to mothers taking TDF in combination with protease inhibitor therapy. Further studies should evaluate ART during pregnancy and breastfeeding.

The CIPHER project

Dr Ngongondo is conducting a prospective cohort study recruiting breastfeeding women living with HIV receiving TDF/3TC/ATV/r and their infants, and then following them from birth to 12 months old. The study will measure ATV/r and TDF concentrations at birth and at three, six and 12 months after birth. Results will be compared with results from a similar study that evaluated the regimen TDF/3TC/EFV.

The goal is to evaluate safety of breastfeeding when an infant is exposed to ART through breastmilk. Specifically, it aims to measure the concentrations of plasma ATV/r and TDF in breastfeeding mothers living with HIV on TDF/3TC/ATV/r. There is conflicting information about whether low TDF concentrations demonstrated in breast milk are at levels that are significant enough to cause toxicity in infants and to select resistant HIV virus.

The impact

Regimens with ATV/r and TDF are important for treating HIV infection in many countries. In Malawi, these drugs are part of the second-line regimen for treating HIV. Evidence from this study will guide decision making around safety in breastfeeding infants exposed to the drugs through breastmilk.

Subsequent funding from the UJMT Fogarty Global Health Fellows Program has allowed Dr Ngongondo to devote his time to his research and scientific activities.