What is the role of nucleotide analogue reverse transcriptase inhibitors in the management of pregnant women with HIV infection?

Updated: Apr 02, 2019
  • Author: Ashley T Peterson, MD; Chief Editor: Ronald M Ramus, MD  more...
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Answer

Answer

The NRTIs are generally well tolerated and cross the placenta with a variable safety profile depending on the agent used. These drugs do bind to mitochondrial DNA gamma polymerase and may cause mitochondrial dysfunction manifesting as cardiomyopathy, neuropathy, lactic acidosis, and liver dysfunction. Genetic susceptibility to these drugs may play a role, and the effects usually resolve with cessation of the medication. [1]

The combination of didanosine and stavudine has been associated with lactic acidosis and hepatic failure leading to fatalities and should be used with caution or only in cases where other NRTIs cannot be used due to resistance or toxicity. Finally, ZDV and stavudine have overlapping toxicities and are antagonistic and should be avoided in combination. [28]


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