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

What's New in the Guidelines

Last Updated: December 12, 2019; Last Reviewed: December 12, 2019

Use of Dolutegravir in Pregnant Women and Women Who Are Trying to Conceive

The Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission (the Panel) has updated recommendations regarding the use of dolutegravir (DTG) in pregnant women and women who are trying to conceive based on data available as of August 2019.

Restrictions on use of DTG during the first trimester and in women who are trying to conceive have been removed. DTG is now a Preferred antiretroviral (ARV) drug throughout pregnancy and an Alternative ARV drug for women who are trying to conceive. Panel members weighed not only the updated data about DTG-associated risk of infant neural tube defects (NTDs) in Botswana, but also the important lack of comparable data about the risk of NTDs when using DTG in other settings, and what is known about the risk of NTDs and other adverse pregnancy outcomes, such as preterm birth, when using other Preferred and Alternative ARV drugs and drug combinations. The Panel has emphasized the importance of counseling and informed decision-making regarding all ARV regimens for people with HIV, and has added a guide to assist health care providers in counseling patients about the use of DTG.

The sections listed below were revised to include updated data, recommendations, and guidance about the use of DTG in pregnant women and in women who are trying to conceive:

• Teratogenicity
• Recommendations for Use of Antiretroviral Drugs During Pregnancy
  • Table 6. What to Start: Initial Combination Regimens for Antiretroviral-Naive Pregnant Women
  • Table 7. Situation-Specific Recommendations for Use of Antiretroviral Drugs in Pregnant Women and Nonpregnant Women Who Are Trying to Conceive
• Pregnant Women Living with HIV Who Have Never Received Antiretroviral Drugs
• Pregnant Women Living with HIV Who are Currently Receiving Antiretroviral Therapy
• HIV-2 Infection and Pregnancy
• Acute HIV Infection
• Dolutegravir
• Appendix D. Dolutegravir Counseling Guide for Health Care Providers