Recommendations for Use of Antiretroviral Drugs During Pregnancy
Pregnant Women Living with HIV Who Are Currently Receiving Antiretroviral Therapy
Last Updated: December 12, 2019; Last Reviewed: December 12, 2019
Panel's Recommendations for Pregnant Women Living with HIV Who Are Currently Receiving Antiretroviral Therapy
- Women living with HIV who are receiving antiretroviral therapy (ART) and who present for pregnancy care should continue their ART during pregnancy, provided that the regimen is tolerated, safe, and effective in suppressing viral replication (defined as a regimen that maintains an HIV viral load less than lower limits of detection of the assay) (AII).
- Women who present during pregnancy on drugs that are not recommended for use because of toxicity (e.g., stavudine, didanosine) should stop taking these drugs and be switched to other antiretroviral (ARV) drugs that are recommended for use in pregnancy (AIII). See Table 5 for more information.
- For pregnant women who are receiving dolutegravir (DTG) and present to care during pregnancy, providers should counsel these women about the risks and benefits of continuing DTG or switching to another ARV regimen (AIII). In most cases, the Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission recommends continuation of DTG (AIII).
- There are no data on the use of two-drug regimens during pregnancy (e.g., DTG plus lamivudine, DTG plus rilpivirine); women who present to care on one of these regimens should switch regimens or add additional ARV agents to these regimens.
- Regimens that contain atazanavir/cobicistat, darunavir/cobicistat, or elvitegravir/cobicistat are associated with pharmacokinetic changes and an increased risk of virologic failure in the second and third trimesters of pregnancy (see Table 4 and Table 5); when a pregnant woman presents to care on one of these regimens, providers should consider switching her to a more effective regimen that is recommended for use in pregnant women (BIII). If one of these regimens is continued, absorption should be optimized, and viral load should be monitored frequently (i.e., every 1–2 months).
- If an ARV regimen is altered during pregnancy, drugs in the new regimen should include ARV drugs that are recommended for use in pregnancy (see Table 4 and Table 5 (BIII), and more frequent virologic monitoring is warranted (CIII).
- ARV drug-resistance testing should be performed to assist the selection of active drugs when changing ARV regimens in pregnant women who are experiencing virologic failure on ART and who have HIV RNA levels >500 copies/mL to 1,000 copies/mL (AII). In individuals who have HIV RNA levels >500 copies/mL but <1,000 copies/mL, testing may be unsuccessful but should still be considered (BII). See Lack of Viral Suppression for more information.
- Clinicians should discuss future reproductive plans and timing as well as the risks and benefits of conceiving on specific ARV medications and use of appropriate contraceptive options to prevent unintended pregnancy (AIII).