Management of HIV Infection during Pregnancy in the United States: Updated Evidence-Based Recommendations and Future Potential Practices

Table 2

Treatment regimens for HIV-infected pregnant women.

Brand name	Preparation	Comments
Preferred regimens
Two-NRTI backbone
Trizivir	ABC/3TC	Patients with an HIV RNA viral load > 100,000 copies/mL should not receive a combination therapy consisting of ABC/3TC with ATV/ritonavir or efavirenz.
Truvada	TDF/FTC or 3TC	TDF-based dual NRTI combinations should be used with caution in patients with renal insufficiency.
Combivir	ZDV/3TC	NRTI combination therapy requires twice daily administration and increases potential for hematologic toxicities.
Protease inhibitor regimens
Reyataz	ATV/r plus a two-NRTI backbone	Maternal hyperbilirubinemia.
Prezista	DRV/r plus a two-NRTI backbone	Must be used twice daily in pregnancy.
NNRTI regimen
Efavirenz	EFV plus a two-NRTI backbone	Concern because of birth defects seen in primate study, unclear risk in humans.
Integrase inhibitor regimen
Raltegravir	RAL plus a two-NRTI backbone	Rapid viral load reduction. Twice-daily dosing required.
Alternative regimens
Protease inhibitor regimens
Kaletra	LPV/r	More nausea than preferred regimens. Twice-daily administration in pregnancy.
NNRTI regimens
Complera	RPV/TDF/FTC (or RPV plus a two-NRTI backbone)	RPV not recommended with pretreatment HIV RNA > 100,000 copies/mL or CD4 cell count < 200 cells/mm^3. Do not use with PPIs. PK data available in pregnancy but relatively little experience with use in pregnancy. Available in co formulated single-pill once daily regimen.

NRTI: nucleoside or nucleotide reverse transcriptase inhibitor, NNRTI: nonnucleoside or nonnucleotide reverse transcriptase inhibitor, ABC: abacavir, 3TC: lamivudine, TDF: tenofovir disoproxil, FTC: emtricitabine, ZDV: zidovudine, ATV: atazanavir, r: ritonavir (boosted regimen), DRV: darunavir, EFV: efavirenz, recommended to be started after 8 weeks of gestation, RAL: raltegravir, LPV: lopinavir, and RPV: rilpivirine.