What are alternative initial antiretroviral therapy (ART) regimens for pregnant women with HIV infection?

Updated: Jun 23, 2020
  • Author: Madhu Chhanda Choudhary, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

Alternative regimens are designated as alternatives for initial therapy in pregnant women when clinical trial data in adults show efficacy but one or more of the following conditions apply: [1]

  • Limited experience in pregnancy
  • Lack of data on teratogenic effects on the fetus
  • Dosing, formulation, administration, or interaction issues for that drug or regimen

NRTI backbone

Zidovudine with lamivudine (300 mg ZDV/150 mg 3TC) twice a day: Combination with most experience in pregnancy; can cause hematological toxicity

Protease inhibitor ̶ based  regimen

Lopinavir (LPV) 400 mg plus  ritonavir (RTV) 100 mg PO twice a day if no lopinavir-associated mutations: Insufficient data for any dosage recommendations in the presence of any lopinavir-associated resistance substitution; [13] some clinicians increase dose to 600 mg/150 mg twice a day in second and third trimester of pregnancy; once-daily LPV/RTV dosing is not recommended during pregnancy; oral solution should not be used in pregnancy because of its high alcohol content

Non-nucleoside reverse transcriptase inhibitors ̶ based regimen

Regimens include the following:

  • Efavirenz (EFV) 600 mg PO daily: Although there are concerns of potential neural tube defects in women of childbearing age before pregnancy is detected, increasing data in pregnancy are reassuring [14] or
  • Rilpivirine (RPV) 25 mg PO daily if pretreatment HIV viral load is less than 100,000 copies/mL and CD4 exceeds 200 cells/mm 3. Limited pregnancy data with highly variable pharmacokinetics.

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