Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States

Recommendations for Use of Antiretroviral Drugs During Pregnancy

Antiretroviral Therapy for People With HIV Who Are Trying to Conceive

Antiretroviral therapy (ART) should be initiated and viral suppression (undetectable HIV RNA) achieved prior to pregnancy whenever possible. People should be given information about the benefits and risks of initiating specific antiretroviral (ARV) regimens when trying to conceive so they can make informed decisions about their care (see Appendix C: Antiretroviral Counseling Guide for Health Care Providers). Prevention of perinatal HIV transmission is maximized in individuals who are on fully suppressive ART prior to conception and remain suppressed during pregnancy and through delivery.¹ (See Prepregnancy Counseling and Care for Persons of Childbearing Age With HIV)

In general, the Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission recommendations for Preferred and Alternative antiretroviral medications are the same for both pregnant people and people trying to conceive who are initiating treatment (see Table 7. Situation-Specific Recommendations for the Use of Antiretroviral Drugs in Pregnant People and Nonpregnant People Who Are Trying to Conceive). However, the time before a planned attempt at conception is an important opportunity to review current ARVs and other options if indicated. This is especially important for regimens that lack pharmacokinetic or safety data and those with possible risk of viral rebound later in pregnancy when medication changes may be more difficult. Importantly, many people who are not trying to conceive, but who are of childbearing potential, may choose ARV regimens that are not designated as Preferred for people trying to conceive. Use of contraception, regardless of type, should not be required to initiate or continue ARVs that would otherwise be recommended for an individual patient, even if there are limited data in pregnancy (e.g., long-acting cabotegravir/rilpivirine or bictegravir/tenofovir alafenamide/emtricitabine). Clinicians should engage in shared decision-making, counsel on the potential risks and benefits, and be aware of the potential for reproductive coercion.

References

1. Sibiude J, Le Chenadec J, Mandelbrot L, et al. Update of perinatal HIV-1 transmission in France: zero transmission for 5,482 mothers on continuous ART from conception and with undetectable viral load at delivery. Clin Infect Dis. 2022. Available at: https://www.ncbi.nlm.nih.gov/pubmed/36037040.