Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Nucleoside and Nucleotide Analogue Reverse Transcriptase Inhibitors

Abacavir (Ziagen, ABC)

Last Updated: December 24, 2019; Last Reviewed: December 24, 2019

Excerpt from Table 8

Note: When using FDC tablets, refer to other sections in Appendix B and Table 8 for information about the dosing and safety of individual drug components of the FDC tablet during pregnancy.

Excerpt from Table 8
Generic Name
(Abbreviation)
Trade Name
Formulation Dosing Recommendationsa Use in Pregnancy
Abacavir
(ABC)
Ziagen

(ABC/3TC)
Epzicom

(ABC/DTG/3TC)
Triumeq

(ABC/3TC/ZDV)
Trizivir

Note: Generic products are available for some formulations.
ABC (Ziagen)d
Tablet:
  • 300 mg
Oral Solution:
  • 20 mg/mL
ABC/3TC (Epzicom):d
  • ABC 600 mg/3TC 300 mg tablet
ABC/DTG/3TC (Triumeq):
  • ABC 600 mg/DTG 50 mg/3TC 300 mg tablet
ABC/3TC/ZDV (Trizivir):d
  • ABC 300 mg/3TC 150 mg/ZDV 300 mg tablet
Standard Adult Doses
ABC (Ziagen):
  • ABC 300 mg twice daily or ABC 600 mg once daily, without regard to food
ABC/3TC (Epzicom):
  • One tablet once daily without regard to food
ABC/DTG/3TC (Triumeq):
  • One tablet daily without regard to food
ABC/3TC/ZDV (Trizivir):
  • One tablet twice daily without regard to food
Pregnancy
PKs in Pregnancy:
  • PKs not significantly altered in pregnancy.
Dosing in Pregnancy:
  • No change in dose indicated.
For guidance about use of combination products in pregnancy, please see the specific sections on other components (i.e., 3TC, ZDV, DTG).
High placental transfer to fetus.b

No evidence of human teratogenicity (can rule out 1.5-fold increase in overall birth defects).

HSRs occur in approximately 5% to 8% of nonpregnant individuals. A small percentage of reactions are fatal, and these fatal reactions are usually associated with re-challenge. Rate of reactions during pregnancy is unknown. Testing for HLA-B*5701 identifies patients at risk of reactions, and a patient’s status should be documented as negative before initiating ABC. Patients should be educated regarding symptoms of HSR.
a Individual ARV drug doses may need to be adjusted in patients with renal or hepatic insufficiency (for details, see the Adult and Adolescent Antiretroviral Guidelines, Appendix B, Table 10).
b Placental transfer categories are determined by mean or median cord blood/maternal delivery plasma drug ratio:
          High: >0.6
          Moderate: 0.3–0.6
          Low: <0.3
d Generic formulation available

Key: 3TC = lamivudine; ABC = abacavir; ARV = antiretroviral; DTG = dolutegravir; FDC = fixed-dose combination; HSR = hypersensitivity reaction; PK = pharmacokinetic; ZDV = zidovudine

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