Antiretroviral drugs in the perinatal period
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ANTIRETROVIRAL DRUGS IN THE PERINATAL PERIOD. Use of ARV Drugs by HIV-Infected Pregnant Women and Their Infants. Considerations for choice of ARV drugs for pregnant women include: Possible changes in dosing requirements resulting from physiologic changes associated with pregnancy

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Antiretroviral drugs in the perinatal period

ANTIRETROVIRAL DRUGS INTHE PERINATAL PERIOD


Use of arv drugs by hiv infected pregnant women and their infants
Use of ARV Drugs by HIV-Infected Pregnant Women and Their Infants

  • Considerations for choice of ARV drugs for pregnant women include:

    • Possible changes in dosing requirements resulting from physiologic changes associated with pregnancy

    • Potential exacerbation of ARV drug toxicities

    • Pharmacokinetics and toxicity of transplacentally transferred drugs

    • Potential short- and long-term effects of ARV drugs on fetuses and newborns

www.aidsetc.org


Combination art and pregnancy outcome
Combination ART and Pregnancy Outcome Infants

  • Possible small increased risk of preterm birth in pregnant women receiving protease inhibitor (PI)-based ART; however, given the clear benefits, PIs should not be withheld for fear of altering pregnancy outcome. (AII)

www.aidsetc.org


Pharmacokinetic changes
Pharmacokinetic Changes Infants

  • Altered dosing during pregnancy may be required for some PIs, such as lopinavir/ritonavir. (AII)

    • Concentrations of the following drugs are reduced during the 2nd and/or 3rd trimesters

      • Lopinavir/ritonavir (LPV/r)

      • Atazanavir (ATV)

      • Darunavir (DRV)

      • Nelfinavir (NFV)

    • The need for dosage adjustment depends on the patient’s treatment experience and use of concomitant medications.

www.aidsetc.org


Teratogenicity
Teratogenicity Infants

  • Women of childbearing potential should undergo pregnancy testing before initiating efavirenz(EFV) and receive counseling about the potential risk to the fetus and desirability of avoiding pregnancy while on EFV. (AIII)

  • Consider non-EFV regimens in patients who are: (BIII)

    • Planning to become pregnant

    • Sexually active and not using effective contraception

www.aidsetc.org


Report Infantsall cases of ARV use in pregnant women to the Antiretroviral Pregnancy Registry: http://www.APRegistry.com(AIII)

The registry collects observational, nonexperimental data regarding ARV exposure during pregnancy to assess potential teratogenicity.

www.aidsetc.org

August 2012


Nevirapine and hepatic rash toxicity
Nevirapine and Hepatic/Rash Toxicity Infants

  • Avoid initiating NVP in women with CD4 counts >250 cells/µL unless the benefits outweigh the risks. (AII)

    • Risk of hepatotoxicity/hypersensitivity reaction

  • Women who are tolerating NVP-containing regimens and become pregnant can continue regardless of CD4 count. (AII)

www.aidsetc.org


Nrti drugs and mitochondrial toxicity
NRTI Drugs and Mitochondrial Toxicity Infants

  • The combination of stavudine (d4T) and didanosine (ddl) should not be prescribed during pregnancy because of reports of lactic acidosis and maternal/neonatal mortality with prolonged use during pregnancy. (AII)

  • Mitochondrial dysfunction should be considered in uninfected children with perinatal exposure to ARV drugs who present with severe clinical findings, particularly neurologic. (AII)

  • Long-term clinical follow-up is recommended for any child with in utero exposure to ARV drugs. (AIII)

www.aidsetc.org


Protease inhibitors and hyperglycemia
Protease Inhibitors and Hyperglycemia Infants

  • HIV-infected women taking ARV regimens during pregnancy should undergo standard glucose screening at 24-28 weeks’ gestation. (AIII)

  • Owing to linkage with hyperglycemia:

    • Consider earlier glucose screening in women receiving PI-based regimens initiated before pregnancy. (BIII)

www.aidsetc.org


Nucleoside and nucleotide reverse transcriptase inhibitors 1
Nucleoside and Nucleotide Reverse Transcriptase InfantsInhibitors (1)

www.aidsetc.org





Nonnucleoside reverse transcriptase inhibitors nrtis 1
Nonnucleoside Infants Reverse Transcriptase Inhibitors (NRTIs) (1)

www.aidsetc.org


Nonnucleoside reverse transcriptase inhibitors nrtis 2
Nonnucleoside InfantsReverse Transcriptase Inhibitors (NRTIs) (2)

www.aidsetc.org


Nonnucleoside reverse transcriptase inhibitors nrtis 3
Nonnucleoside InfantsReverse Transcriptase Inhibitors (NRTIs) (3)

www.aidsetc.org


Protease inhibitors 1
Protease Inhibitors Infants(1)

Class concerns for PIs: hyperglycemia, diabetes, question of increased risk of preterm delivery

www.aidsetc.org


Protease inhibitors 2
Protease Inhibitors Infants(2)

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Protease inhibitors 3
Protease Inhibitors Infants(3)

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Additional recommendations by class
Additional Recommendations by Class Infants

Integrase Inhibitors

Entry Inhibitors

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