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Issue No. 24 | October 20, 2017

News and Features

Perinatal Antiretroviral Treatment Guidelines Updated

The Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States were recently updated. The following is a summary of what’s changed in this revision:

Recommendations for Use of Antiretroviral Drugs during Pregnancy and Table 6: What to Start: Initial Combination Regimens for Antiretroviral-Naive Pregnant Women

  • This section was updated to include new data and publications where relevant.
  • After review of available study findings, the Panel continues to recommend tenofovir as a component of first-line therapy and zidovudine as a second-line agent for use in antiretroviral-naive pregnant women living with HIV in the United States.
  • Based on limited but increasing experience with use in pregnancy, dolutegravir is now classified as an Alternative agent for antiretroviral-naive pregnant women.
  • The Panel has changed its classification of elvitegravir/cobicistat to Not Recommended for Initial Use in Pregnancy based on data showing inadequate levels of both drugs during the 2nd and 3rd trimester as well as viral breakthroughs.
  • When a pregnant woman presents on elvitegravir/cobicistat regimens, providers should consider switching to a more effective regimen. If elvitegravir/cobicistat regimens are continued, viral load should be monitored frequently and therapeutic drug monitoring may be useful.
  • Maraviroc and enfuvirtide are not recommended for use in antiretroviral-naive pregnant women, in accordance with guidelines for non-pregnant adults and due to lack of pharmacokinetic and safety data in pregnancy.

Table 8: Antiretroviral Drug Use in Pregnant HIV-Infected Women: Pharmacokinetic and Toxicity Data in Human Pregnancy and Recommendations for Use in Pregnancy and Appendix B: Safety and Toxicity of Individual Antiretroviral Agents in Pregnancy

  • These sections were updated with new data about tenofovir disoproxil fumarate.

Adult and Adolescent Opportunistic Infections Guidelines Updated

The Candida section of the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents was recently updated. This section was updated a) to include isavuconazole as a treatment option for patients with uncomplicated esophageal candidiasis, b) to highlight the results of a study describing complications from fluconazole use during pregnancy, and c) to incorporate statements regarding the occurrence of infections by non-albicans Candida strains, the presence of drug-drug interactions and absorption considerations with posaconazole, and the importance of ART/immune restoration in preventing mucosal candidiasis.

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