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 7, 2018; Last Reviewed: December 7, 2018

Excerpt from Table 10a

Note: When using FDCs, refer to other sections in Appendix B and Table 10 for information about the dosing and safety of individual drug components of the FDC during pregnancy.

Generic Name
(Abbreviation)
Trade Name
Formulation Dosing Recommendations Use in Pregnancy
Abacavir
(ABC)
Ziagen

(ABC/3TC)
Epzicom

(ABC/3TC/ZDV)
Trizivir

(ABC/DTG/3TC)
Triumeq

Note: Generic available for some formulations.
ABC (Ziagen)d
Tablet:
  • 300 mg
Solution:
  • 20 mg/mL
ABC/3TC (Epzicom):d
  • ABC 600 mg plus 3TC 300 mg tablet
ABC/3TC/ZDV (Trizivir):d
  • ABC 300 mg plus 3TC 150 mg plus ZDV 300 mg tablet
ABC/DTG/3TC (Triumeq):
  • ABC 600 mg plus 3TC 300 mg plus DTG 50 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):
  • 1 tablet once daily without regard to food
ABC/3TC/ZDV (Trizivir):
  • 1 tablet twice daily without regard to food
ABC/DTG/3TC (Triumeq):
  • 1 tablet daily without regard to food
Dosing in Pregnancy:
  • No change in dose indicated.
PK in Pregnancy:
  • PK not significantly altered in pregnancy.
  • 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 should be done and documented as negative before starting ABC. Patients should be educated regarding symptoms of HSR.
a Individual ARV drug dosages may need to be adjusted in patients with renal or hepatic insufficiency (for details, see the Adult and Adolescent Guidelines Appendix B, Table 8).
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 is available.

Key to Acronyms: 3TC = lamivudine; ABC = abacavir; DTG = dolutegravir; HSR = hypersensitivity reactions; PK = pharmacokinetic; ZDV = zidovudine

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