Considerations for Antiretroviral Use in Special Patient Populations
Women with HIV
Last Updated: December 18, 2019; Last Reviewed: December 18, 2019
Panel's Recommendations for Women with HIV
Key Considerations and Recommendations
- Antiretroviral therapy (ART) is recommended for all persons living with HIV to improve their health and to reduce the risk of HIV transmission to sexual partners without HIV (AI).
- When prescribing antiretroviral (ARV) drugs, clinicians should take into account that some ARV drugs have significant pharmacokinetic (PK) interactions with hormonal contraceptives; an alternative or additional effective contraceptive method is recommended to prevent unplanned pregnancy (AIII). Switching to an ARV drug that does not have interactions with hormonal contraceptives may also be considered (BIII).
- A pregnancy test should be performed for those of childbearing potential prior to initiation of ART (AIII).
- Preliminary data suggest there may be an increased risk of neural tube defects (NTDs) (0.9%) in infants born to women who were receiving dolutegravir (DTG) at the time of conception. Updated results have shown that the prevalence of NTDs in infants who were exposed to DTG at the time of conception is lower (0.3%) than reported in the preliminary data, but still higher than in infants born to women who received ART that did not include DTG (0.1%).
- Providers should discuss the potential risks and benefits of using DTG with individuals of childbearing potential and provide appropriate counseling so that individuals can make informed decisions.
- Before initiating an integrase strand transfer inhibitor-based regimen in a person of childbearing potential, clinicians should review Table 6b for information to consider when choosing an ART regimen.
- In a patient with multidrug-resistant HIV who has no alternatives to DTG, the decision of whether to use DTG should be made after carefully considering the risk of NTDs in the infant if pregnancy occurs while a patient is taking DTG, and the risks of persistent viremia in the patient and potential HIV transmission to the fetus if pregnancy occurs while the patient is not on effective ART.
- During pregnancy, an additional goal of ART is to maintain a viral load below the limit of detection throughout pregnancy to reduce the risk of transmission to the fetus and newborn (AI).
- When selecting an ARV combination regimen for a pregnant woman, clinicians should consider the available safety, efficacy, and PK data on use during pregnancy for each agent. The risks and benefits of ARV use during pregnancy should be discussed with all individuals of childbearing potential (AIII) and clinicians should consult the most current Perinatal Guidelines when designing a regimen (AIII).