Efficacy and Safety of Antivirals in Lactating Women with Herpesviridae Infections: A Systematic Review.

Herpesviruses are prevalent pathogens affecting lactating women, yet the safety and efficacy of antiviral therapies in this population remain underexplored. This systematic review evaluates the safety and efficacy of antiviral therapies for Herpesviridae infections, including CMV, VZV, EBV, and HSV, in lactating mothers. A comprehensive literature search was conducted using PubMed, Cochrane Library, and Scopus, alongside specialized databases like LactMed. Twelve studies were included, comprising three randomized control trials, five observational studies, and four case reports. Quality assessment using Joanna Briggs Institute tools indicated moderate-to-high methodological quality for the trials and consistent strengths in case reports, though some limitations were noted. Results suggest that antiviral agents, particularly acyclovir and valacyclovir, are generally safe for breastfeeding mothers, with minimal infant exposure and low risk of adverse effects. However, the virologic benefits appear modest, and most studies focused on HIV co-infected populations, limiting generalizability to lactating women without HIV. In conclusion, while current evidence supports the use of specific antivirals during lactation, there is a critical need for further research to address existing knowledge gaps and optimize treatment strategies for both mothers and infants.