Updated Guidelines for Pregnant Women with HIV and Preventing Mother-to-Child Transmission

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The U.S. Department of Health and Human Services last week released an update to its Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Notable changes include discussion of antiretroviral treatment as prevention and pre-exposure prophylaxis (PrEP) for serodiscordant couples wishing to conceive, and a new section on options for perinatally infected women who are now pregnant themselves.

Key changes to the recommendations are summarized in What's New in the Guidelines, and additions and revisions are highlighted in yellow throughout the text and tables of the online guidelines document.

Changes include:

o   Ritonavir-boosted darunavir (Prezista) has been promoted to a preferred protease inhibitor for treatment-naive pregnant women, boosted atazanavir (Reyataz) remains on the preferred list, but lopinavir/ritonavir (Kaletra) has been demoted to an alternative.

o   Efavirenz remains a preferred NNRTI when initiated after the first 8 weeks of pregnancy, while rilpivirine (Edurant) has been added as an alternative.

o   Raltegravir has been promoted to the first preferred integrase inhibitor for initial treatment of pregnant women.

o   Boosted saquinavir (Invirase) and nevirapine (Viramune) are no longer recommended for initial therapy for treatment-naive pregnant women.

o   There are insufficient data to recommend cobicistat (Tybost) as a booster for pregnant women.

8/12/15

Reference

U.S. Department of Health and Human Services. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Updated July 6, 2015.