What is the role of efavirenz (EFV) in antiretroviral therapy (ART) 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

There had been concerns of neural tube defect due to efavirenz exposure during conception and first trimester. However, the risk of neural tube defect associated with efavirenz appears to be similar to that in the general population; therefore, efavirenz should be continued in women who become pregnant while receiving an efavirenz-containing regimen for viral suppression. [14] The TSEPAMO study in Botswana redemonstrated the safety of efavirenz in pregnancy, with the occurrence of only one case of skeletal dysplasia in an efavirenz-exposed infant among 395 women with first-trimester exposure to efavirenz-based ART. [11]

However, the SMARTT observational cohort of HIV exposed and uninfected children found that in utero exposure to an efavirenz-containing regimen was associated with an increased risk of microcephaly. This association was more pronounced when efavirenz was combined with zidovudine as opposed to tenofovir-containing regimen. [18] In another analysis of HIV-exposed but uninfected children exposed to specific antiretrovirals in utero, a higher risk of neurological disease with efavirenz exposure was redemonstrated. [19]


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