Is Ibalizumab Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Ibalizumab? Is Ibalizumab safe for nursing mother and child? Does Ibalizumab extracts into breast milk? Does Ibalizumab has any long term or short term side effects on infants? Can Ibalizumab influence milk supply or can Ibalizumab decrease milk supply in lactating mothers?

No information is available on the clinical use of ibilizumab during breastfeeding. Because ibilizumab is a large protein molecule with a molecular weight of 150,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, ibilizumab-uiyk should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends avoiding breastfeeding while taking ibilizumab. 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, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life.[1] The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.[2][3] Ibilizumab is a human immunoglobulin G4 (IgG4) antibody. Holder pasteurization (62.5 degrees C for 30 minutes) decreases the concentration of endogenous immunoglobulin G by up to 79%.[4][5] A study of 67 colostrum samples that underwent Holder pasteurization found that IgG amounts decreased by 34 to 40%. Specific IgG subclasses decreased by different amounts, with Holder pasteurization having little effect on IgG4 activity.[6] None of the studies measured IgG activity.