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

Table 3

Pregnancy outcomes of individual antiretroviral agents during pregnancy.

Brand name	⁢Reported adverse pregnancy outcomes
	Maternal	Fetal/neonatal
NRTI
Zidovudine	Potential for hematologic toxicities (anemia and bone marrow suppression) [52], including elevated liver function tests [53], myelotoxicity [54], acute pancreatitis [54], preeclampsia, and other hypertensive disorders [55]	PTD [37], SGA [37], LBW [37], and CHD [35]
Tenofovir disoproxil fumarate	Kidney [56] and bone toxicity [57]	Decreased bone mineral density content [58]
NNRTI
Efavirenz	Rash and drug interactions [59]	Initial concern of birth defects seen in primate study [60]; however, recent studies have not shown an increased risk of neural tube defects [61]
Abacavir	Abacavir should not be used in patients who test positive for HLA-B5701 because a positive test may increase the risk of a hypersensitivity reaction [56], nausea, vomiting, diarrhea, and abdominal pain [59]	None
Didanosine	Pancreatitis (acute and chronic) [54] and neuropathy	Initial studies concerning for an association with fetal anomalies, specifically head and neck anomalies when exposed during the first trimester [35]; however, recent studies found no adverse outcomes [62]
Nevirapine	10-fold increased risk of hepatotoxicity [63, 64]	No reported fetal malformations [64]
Emtricitabine	Headache, nausea, vomiting, and diarrhea [59]	None [65]
Protease inhibitors
Ritonavir	Nausea, vomiting, increased triglycerides, and transaminases [59]
Atazanavir	Abdominal pain, diarrhea, nausea, and increased liver function tests [59]	PTD [31, 32, 34, 66]
Lopinavir	Nausea, vomiting, diarrhea, and pancreatitis [59]	PTD [21, 31, 34, 66]
Darunavir	Maternal hyperbilirubinemia and nausea [59]	PTD [31, 32, 34, 66]

Table provides a short list of the updated ARV’s and their reported safety issues.
Nevirapine can cause fatal and severe hepatotoxicity among women with CD4 lymphocytes > 250 cells/μL.
NRTI: nucleoside or nucleotide reverse transcriptase inhibitor, NNRTI: nonnucleoside or nonnucleotide reverse transcriptase inhibitor, PTD: preterm delivery (delivery prior to 37 weeks), SGA: small for gestational age (birth weight less than the 10th percentile for their gestational age), LBW: low birth weight (birth weight less than 2500 grams), and CHD: congenital heart defects.