Considerations for Antiretroviral Use in Special Patient Populations
Women with HIV
Last Updated: October 25, 2018; Last Reviewed: October 25, 2018
Panel's Recommendations for Women with HIV
- Antiretroviral therapy (ART) is recommended for all persons living with HIV to improve their health and to reduce the risk of HIV transmission to sex 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 to prevent unplanned pregnancy is recommended (AIII). Switching to an ARV drug without 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 (NTD) in infants born to women who were receiving dolutegravir (DTG) at the time of conception. Until more information is available, DTG is not recommended for use in individuals who are pregnant and within 12 weeks post-conception and those who are contemplating pregnancy, unless there are no alternative options (AII).
- Providers should discuss the potential risks and benefits of DTG with individuals of childbearing potential and provide appropriate counseling so that the individual can make an informed decision. For those who are sexually active and not using effective contraception, choosing an alternative to DTG is recommended. For those who are using effective contraception, use of a DTG-based regimen is reasonable after discussing the risks and benefits with the individual.
- Individuals who become pregnant and present for antenatal care at 12 weeks post-conception or later may initiate or continue DTG-based regimens (CIII).
- In a patient with multidrug-resistant HIV who has no alternatives to DTG, the decision of whether to use DTG should be made after careful consideration of 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).