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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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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