Is Atazanavir Safe in Breastfeeding

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

In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Published experience with atazanavir during breastfeeding is limited. 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] The combination product Evotaz, which also contains the CYP3A inhibitor cobicistat, has not been studied during breastfeeding, but would be expected to have similar concerns.

Gynecomastia has been reported among men receiving highly active antiretroviral therapy. Gynecomastia is unilateral initially, but progresses to bilateral in about half of cases. No alterations in serum prolactin were noted and spontaneous resolution usually occurred within one year, even with continuation of the regimen.[5][6][7] Some case reports and in vitro studies have suggested that protease inhibitors might cause hyperprolactinemia and galactorrhea in some male patients,[8][9] although this has been disputed.[10] The relevance of these findings to nursing mothers is not known. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.