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Safety and dosing of antiretroviral medications in pregnancy

Elaine J Abrams, MD
Section Editor
Lynne M Mofenson, MD
Deputy Editor
Allyson Bloom, MD


Decisions regarding antiretroviral therapy in the pregnant female are complex and, beyond the typical considerations of virologic potency, side effects, and formulation, need to also take into consideration other factors, such as possible changes in pharmacokinetics due to physiologic changes, potential toxicities that may be magnified during pregnancy, and potential toxicity to the fetus and/or newborn.

This topic will address the clinical data on the safety and pharmacology of the more commonly used antiretroviral medications during pregnancy. Antiretrovirals that are not commonly used or used only in limited situations are not discussed in this topic. Guidelines for antiretroviral therapy of pregnant HIV-infected women in the United States are developed by the Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission; these guidelines include detailed information on the safety and pharmacokinetics of antiretroviral drugs in pregnancy [1]. Guidelines for antiretroviral therapy of pregnant women residing in resource-limited settings, where antiretroviral drug access may be more limited and preferred drug choices may differ, are developed by the World Health Organization (WHO) and may differ from recommendations in the United States; WHO guideline updates can be found on its website.

Antiretroviral selection and other management issues for the HIV-infected pregnant woman are discussed in detail elsewhere. (See "Antiretroviral and intrapartum management of pregnant HIV-infected women and their infants in resource-rich settings" and "Prenatal evaluation of the HIV-infected woman in resource-rich settings" and "Prevention of mother-to-child HIV transmission in resource-limited settings".)


Antiretroviral therapy (ART) is recommended for all HIV-infected individuals, including pregnant women, regardless of immune, clinical, or viral status [2]. ART reduces HIV-related morbidity and mortality, even in individuals with high CD4 cell counts [3,4]. An additional goal of ART in pregnant women is to decrease the risk of perinatal transmission of HIV infection.

In pregnant women, antiretroviral regimen selection should take into account the resistance profile of the virus, the safety and efficacy of the drugs in the mother and fetus, the convenience and adherence potential of the regimen, the potential for drug interactions with other medications, and pharmacokinetic data in pregnancy. In resource-rich settings, certain antiretroviral agents that are recommended in the general HIV-infected population are not preferred agents for pregnant women because of limited experience during pregnancy. On the other hand, certain agents that are not recommended in the general population are preferred for pregnant women because of extensive clinical experience during pregnancy. In general, treatment-naïve women should be treated with a regimen made up of preferred agents, if the resistance profile of the virus allows. Treatment-experienced women on a suppressive antiretroviral regimen can continue it even if the agents are not specifically preferred during pregnancy. Preferred antiretroviral agents in pregnancy and regimen selection for pregnant women are discussed in detail elsewhere. (See "Antiretroviral and intrapartum management of pregnant HIV-infected women and their infants in resource-rich settings" and "Prevention of mother-to-child HIV transmission in resource-limited settings".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 13, 2017.
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