When is a change in antiretroviral therapy (ART) regimen indicated 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

In general, women who are receiving ART for HIV infection should continue the same regimen during pregnancy, if it is well tolerated and yields effective HIV virologic suppression. [15]

The following regimens require changes during pregnancy:

  • If the regimen contains stavudine, didanosine, or full-dose ritonavir, a regimen change is strongly considered.
  • Cobicistat-boosted elvitegravir: Compared with paired postpartum data, elvitegravir AUC was 24% lower in the second trimester and 44% lower in the third trimester, while cobicistat AUC was 44% and 59% lower in second and third trimester, respectively. Elvitegravir/cobicistat (EVG/c) is not recommended for initial use in pregnancy. Women who become pregnant while taking EVG/c should be offered an alternate regimen. If an EVG/c regimen is continued, the viral load should be monitored frequently, and therapeutic drug monitoring, if available, may be useful. [16]
  • Cobicistat-boosted darunavir is not recommended for use during pregnancy, as mean darunavir minimum concentrations (C min) were approximately 90% lower during the second and third trimester compared with postpartum levels. Therefore, darunavir/cobicistat (DRV/c) is not recommended during pregnancy. An alternative regimen is recommended for individuals who become pregnant during therapy with DRV/c-containing regimen. [17]
  • There are no data on 2-drug regimens such as DTG-RPV or DTG-3TC in pregnancy. Therefore, an additional ARV agent or regimen change is recommended.

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