Generic Name (Abbreviation) Trade Name | Formulation | Dosing Recommendationsa | Use in Pregnancy | Last Reviewed |
---|---|---|---|---|
NRTIs NRTIs interfere with HIV reverse transcriptase by competitive inhibition. Nucleoside analogue drugs require three intracellular phosphorylation steps to form the triphosphate nucleoside, which is the active drug moiety. The nucleotide analogue tenofovir contains a monophosphate component attached to the adenine base and requires only two phosphorylation steps to form the active moiety. | ||||
Abacavir (ABC) Ziagen (ABC/3TC) Epzicom (ABC/DTG/3TC) Triumeq (ABC/3TC/ZDV) Trizivir Note: Generic products are available for some formulations. | ABC (Ziagen)c
Oral Solution
ABC/3TC (Epzicom)c
ABC/DTG/3TC (Triumeq)
ABC/3TC/ZDV (Trizivir)c
| Pregnancy
Dosing in Pregnancy
For guidance about use of combination products in pregnancy, please see the specific sections on other components (i.e., 3TC, ZDV, DTG).
ABC/3TC (Epzicom)
ABC/DTG/3TC (Triumeq)
ABC/3TC/ZDV (Trizivir)
| High placental transfer to fetus.b No evidence of human teratogenicity (can rule out 1.5-fold increase in overall birth defects). HSRs occur in approximately 5% to 8% of nonpregnant individuals. A small percentage of reactions are fatal, and these fatal reactions are usually associated with re-challenge. The rate of reactions during pregnancy is unknown. Testing for HLA-B*5701 identifies patients at risk of reactions, and a patient’s status should be documented as negative before initiating ABC. Patients should be educated regarding symptoms of HSR. | February 20, 2025 |
Emtricitabine Note: Generic products are available for some formulations. | FTC (Emtriva)
Oral Solution
FTC/EFV/TDFc
FTC/BIC/TAF (Biktarvy)
FTC/RPV/TDF (Complera)
FTC/TAF (Descovy)
FTC/EVG/c/TAF (Genvoya)
FTC/RPV/TAF (Odefsey)
FTC/EVG/c/TDF (Stribild)
FTC/DRV/c/TAF (Symtuza)
FTC/TDF (Truvada)c
| Pregnancy
Dosing in Pregnancy
For guidance about the use of combination products in pregnancy, please see the specific sections on other components (i.e., TDF, TAF, EFV, RPV, DRV, EVG, BIC, COBI).
FTC/EFV/TDF
FTC/BIC/TAF (Biktarvy)
FTC/RPV/TDF (Complera)
FTC/TAF (Descovy)
FTC/EVG/c/TAF (Genvoya)
FTC/RPV/TAF (Odefsey)
FTC/EVG/c/TDF (Stribild)
FTC/DRV/c/TAF (Symtuza)
FTC/TDF (Truvada)
| High placental transfer to fetusb If patient has HBV/HIV coinfection, it is possible that an HBV flare may occur if the drug is stopped; see Hepatitis B Virus/HIV Coinfection. | February 20, 2025 |
Lamivudine (3TC) Epivir (3TC/TDF) Cimduo (3TC/ZDV) (3TC/DOR/TDF) Delstrigo (3TC/DTG) Dovato (3TC/ABC) (3TC/EFV/TDF) Symfi (3TC/EFV/TDF) Symfi Lo (3TC/ABC/DTG) Triumeq (3TC/ABC/DTG) TriumeqPD (3TC/ABC/ZDV) Note: Generic products are available for some formulations | 3TC (Epivir)c
Oral Solution
3TC/TDF (Cimduo)
3TC/ZDVc
3TC/DOR/TDF (Delstrigo)
3TC/DTG (Dovato)
3TC/ABCc
3TC/EFV/TDF (Symfi)c
3TC/EFV/TDF (Symfi Lo)c
3TC/ABC/DTG (Triumeq)
3TC/ABC/DTG (TriumeqPD)
3TC/ABC/ZDVc
| Pregnancy
Dosing in Pregnancy
For guidance about the use of combination products in pregnancy, please see the specific sections on other components (ABC, DOR, DTG, EFV, TDF, ZDV).
3TC/TDF (Cimduo)
3TC/ZDV
3TC/DOR/TDF (Delstrigo)
3TC/DTG (Dovato)
3TC/ABC
3TC/EFV/TDF (Symfi or Symfi Lo)
3TC/ABC/DTG (Triumeq)
3TC/ABC/DTG (Triumeq PD)
3TC/ABC/ZDV
| High placental transfer to fetus.b 3TC products developed specifically for treatment of HBV (e.g., Epivir-HBV) contain a lower dose of 3TC that is not appropriate for treatment of HIV. | February 20, 2025 |
Tenofovir Alafenamide (TAF) Vemlidy (TAF/BIC/FTC) Biktarvy (TAF/FTC) Descovy (TAF/EVG/c/FTC) Genvoya (TAF/FTC/RPV) Odefsey (TAF/DRV/c/FTC) Symtuza | TAF (Vemlidy)
TAF/BIC/FTC (Biktarvy)
TAF/FTC (Descovy)
TAF/EVG/c/FTC (Genvoya)
TAF/FTC/RPV (Odefsey)
TAF/DRV/c/FTC (Symtuza)
| Pregnancy
Dosing in Pregnancy
For guidance about the use of combination products in pregnancy, please see the specific sections on other components (i.e., BIC, COBI, DRV, EVG, FTC, RPV). Standard Adult Doses
TAF/BIC/FTC (Biktarvy)
TAF/FTC (Descovy)
TAF/EVG/c/FTC (Genvoya)
TAF/FTC/RPV (Odefsey)
TAF/DRV/c/FTC (Symtuza)
| TAF
TFV
No evidence of human teratogenicity (can rule out twofold increase in overall birth defects) Renal function should be monitored because of the potential for renal toxicity. | February 20, 2025 |
Tenofovir Disoproxil Fumarate (TDF/EFV/FTC) (TDF/3TC) (TDF/FTC/RPV) (TDF/DOR/3TC) (TDF/EVG/c/FTC) (TDF/EFV/3TC) (TDF/EFV/3TC) (TDF/FTC) Note: Generic products are available for some formulations. | TDF (Viread) Tabletc
Powder
TDF/EFV/FTC (Atripla)c,d
TDF/3TC (Cimduo)
TDF/FTC/RPV (Complera)
TDF/DOR/3TC (Delstrigo)
TDF/EVG/c/FTC (Stribild)
TDF/EFV/3TC (Symfi)
TDF/EFV/3TC (Symf Lo)
TDF/3TC (Temixys)
TDF/FTC (Truvada)c
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
For guidance about the use of combination products in pregnancy, please see the specific sections on other components (i.e., 3TC, COBI, DOR, EFV, EVG, FTC, RPV). Standard Adult Doses
TDF/EFV/FTC (Atripla)d
TDF/3TC (Cimduo)
TDF/FTC/RPV (Complera)
TDF/DOR/3TC (Delstrigo)
TDF/EVG/c/FTC (Stribild)
TDF/EFV/3TC (Symfi or Symfi Lo)
TDF/3TC (Temixys)
TDF/FTC (Truvada)
| High placental transfer to fetusb No evidence of human teratogenicity (can rule out 1.5-fold increase in overall birth defects) Human studies demonstrate no consistent link to LBW, but data are conflicting about potential effects on growth outcomes later in infancy. If patient has HBV/HIV coinfection, an HBV flare may occur if TDF is stopped; see Hepatitis B Virus/HIV Coinfection. Renal function should be monitored because of potential for renal toxicity. | February 20, 2025 |
Zidovudine (ZDV) Retrovir (ZDV/3TC) (ZDV/ABC/3TC) Note: Generic products are available for all formulations. | ZDV (Retrovir)
Tablet
Oral Solution
IV Solution
| Pregnancy
Dosing in Pregnancy
For guidance about the use of combination products in pregnancy, please see the specific sections on other components (i.e., ABC, 3TC) Standard Adult Doses
ZDV/ABC/3TC (Trizivir)
| High placental transfer to fetus.b No evidence of human teratogenicity (can rule out 1.5-fold increase in overall birth defects). | February 20, 2025 |
NNRTIs NNRTIs interfere with HIV reverse transcriptase by binding directly to the enzyme. | ||||
Doravirine (DOR/3TC/TDF) | DOR (Pifeltro)
DOR/3TC/TDF (Delstrigo)
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
For guidance about the use of combination ARV drug products in pregnancy, please see the specific sections on other drug components (i.e., 3TC, TDF). Standard Adult Doses DOR (Pifeltro)
DOR/3TC/TDF (Delstrigo)
| No human in vivo data are available on the placental transfer of DOR, but passage is noted in an ex vivo models. Insufficient data are available to assess for teratogenicity in humans. No evidence exists of teratogenicity in rats or rabbits. | February 20, 2025 |
Efavirenz Note: Generic products are available for some formulations. | EFV Capsules
Tablet
EFV/FTC/TDF
EFV/3TC/TDF (Symfi)
EFV/3TC/TDF (Symfi Lo)
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
For guidance about the use of combination products in pregnancy, please see the specific sections on other components (i.e., 3TC, FTC, TDF). Standard Adult Doses EFV (Sustiva)
EFV/FTC/TDF
EFV/3TC/TDF
| Moderate placental transfer to fetus.b The FDA advises women to avoid becoming pregnant while taking EFV and advises health care providers to avoid administration during the first trimester of pregnancy because fetal harm may occur. However, the data on more than 7,900 periconception EFV exposures from Botswana rule out a threefold or greater increased risk of NTDs. As a result, the current Perinatal Guidelines do not restrict the use of EFV during pregnancy or when planning to become pregnant. This is consistent with both the British HIV Association and WHO guidelines for use of ARV drugs in pregnancy. EFV should be continued in pregnancy when a virally suppressive, EFV-based regimen is being received, because ARV drug changes during pregnancy may be associated with loss of viral control and an increased risk of perinatal transmission (see Antiretroviral Therapy Use During Prepregnancy and Early Pregnancy). | February 20, 2025 |
Etravirine (ETR) Intelence | Tablet
For patients who are unable to swallow tablets whole, the tablets may be dissolved in a glass of water. | Pregnancy
Dosing in Pregnancy
Standard Adult Doses
| Placental transfer varies; it is usually in the moderate-to-high category, ranging 0.19–4.25.b Insufficient data to assess teratogenicity in humans; no evidence of teratogenicity in rats or rabbits. | February 20, 2025 |
Nevirapine (NVP) | NVP
Oral Suspension:
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
Standard Adult Doses
| High placental transfer to fetus.b No evidence of human teratogenicity. An increased risk of symptomatic liver toxicity exists when first initiating therapy in women with CD4 counts ≥250/mm3. Liver toxicity is often associated with a rash and can be fatal. Pregnancy does not appear to increase this risk. NVP should be initiated in pregnant people with CD4 counts ≥250 cells/mm3 only if the benefit clearly outweighs the risk. A potential increased risk of life-threatening hepatotoxicity exists in pregnant people with high CD4 counts. Elevated transaminase levels at baseline may increase the risk of NVP toxicity. Patients who become pregnant while taking NVP-containing regimens and who are tolerating their regimens well can continue taking those regimens, regardless of their CD4 counts. | February 20, 2025 |
Rilpivirine (CAB and RPV) CAB and RPV is a two-drug co-packaged product for IM injection. | RPV (Edurant) Tablets
RPV/FTC/TDF (Complera)
RPV/DTG (Juluca)
RPV/FTC/TAF (Odefsey)
CAB and RPV (Cabenuva)
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
For guidance about the use of combination products in pregnancy, please see the specific sections on other components (i.e., CAB, DTG, FTC, TAF, TDF). Standard Adult Doses RPV (Edurant)
RPV/FTC/TDF (Complera)
RPV/DTG (Juluca)
RPV/FTC/TAF (Odefsey)
CAB and RPV (Cabenuva)
| Moderate-to-high placental transfer to fetus.b No evidence of human teratogenicity (can rule out twofold increase in overall birth defects. Two-drug regimens (e.g., the RPV/DTG FDC) are not recommended for use in pregnancy. | February 20, 2025 |
PIs PIs block the activity of the protease enzyme, which is required to assemble new HIV viral particles that are capable of infecting new cells. | ||||
Atazanavir Note: Generic products are available for some formulations. Note: ATV must be combined with low-dose RTV boosting in pregnancy. (ATV/c) | ATV (Reyataz) Capsules
Oral Powder
ATV/c (Evotaz)
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
For guidance about the use of combination products in pregnancy, see the specific sections on other components (i.e., COBI). Standard Adult Doses In ARV-Naive Patients Without RTV Boosting
In ARV-Naive Patients With RTV Boosting
In ARV-Experienced Patients
In ARV-Experienced Patients Who Are Receiving an H2-Receptor Antagonist
In ARV-Experienced Patients Who Are Receiving an H2-Receptor Antagonist and TDF
Powder Formulation
ATV/c (Evotaz)
| Low placental transfer to fetusb Effect of in utero ATV exposure on infant indirect bilirubin levels is unclear. Nonpathologic elevations of neonatal bilirubin have been observed in some, but not all, clinical trials to date. Use of ATV/c is not recommended during pregnancy. See Recommendations for Use of Antiretroviral Drugs During Pregnancy, Table 6 and Table 7 for discussions about avoiding the use of ATV/c during pregnancy. Note: Please see FDA label for full list of drugs with potential interactions, including several anticonvulsants and other drugs for which administration with ATV/r is contraindicated. | February 20, 2025 |
Darunavir Note: Must be combined with low-dose RTV or COBI boosting. (DRV/c) (DRV/c/FTC/TAF) | DRV (Prezista) Tablets
Oral Suspension
DRV/c (Prezcobix)
DRV/c/FTC/TAF (Symtuza)
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
For guidance about use of combination products in pregnancy, please see the specific sections on other components (i.e., COBI, FTC, TAF). Standard Adult Doses Patients Who Are ARV-Naive
ARV-Experienced Patients If Patient Has No DRV Resistance Mutations
ARV-Experienced Patients If Any DRV Resistance Mutations Are Present
DRV/c (Prezcobix)
DRV/c/FTC/TAF (Symtuza)
| Low placental transfer to fetusb No evidence of teratogenicity in mice, rats, or rabbits. No evidence of human teratogenicity. Must be boosted with low-dose RTV The Panel does not recommend once-daily dosing with DRV/r during pregnancy or the use of DRV/c during pregnancy. If a DRV/c regimen is continued during pregnancy, viral load should be monitored frequently. | February 20, 2025 |
Lopinavir/Ritonavir Note: Generic products are available for all formulations. | LPV/r (Kaletra)c
Oral Solution
| Pregnancy
Dosing in Pregnancy
Standard Adult Doses
Tablet
Oral Solution
With EFV or NVP in PI-Naive or PI-Experienced Patients:
| Low placental transfer to fetusb No evidence of human teratogenicity (can rule out 1.5-fold increase in overall birth defects). Oral solution contains 42% alcohol and 15% propylene glycol and is not recommended for use in pregnancy. Once-daily LPV/r dosing is not recommended during pregnancy. | February 20, 2025 |
Entry Inhibitors Entry and attachment inhibitors block viral binding or fusion of HIV to host cells. | ||||
Fostemsavir (FTR) Rukobia |
| Pregnancy
Dosing in Pregnancy
Standard Adult Doses (FTR) Rukobia
| No human data are available regarding placental passage. A study in rats demonstrates placental passage of temsavir or other metabolites. Insufficient data to assess for teratogenicity in humans. No evidence of teratogenicity in rats or rabbits. | February 20, 2025 |
Ibalizumab-uiyk (IBA) Trogarzo | IV Solution
| Pregnancy
Dosing in Pregnancy
Standard Adult Doses IV infusion (diluted infusion with 250 mL 0.9% sodium chloride)
IV push (undiluted)
| No human data are available, but placental transfer of IBA, a monoclonal antibody, is possible and documented in monkeys. Based on data in cynomologus monkeys with in utero exposure, potential exists for reversible immunosuppression (CD4 T-cell and B-cell lymphocytopenia) in infants born to individuals exposed to IBA during pregnancy. The FDA requires collection of prospective data on IBA exposure during pregnancy to monitor maternal and pregnancy outcomes, including adverse effects on the developing fetus, neonate, and infant. Insufficient data to assess for teratogenicity in humans. | February 20, 2025 |
Maraviroc (MVC) Selzentry | Tablets
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
Standard Adult Doses
Dose Adjustments
| Moderate placental transfer to fetusb No evidence of teratogenicity in rats or rabbits; insufficient data to assess for teratogenicity in humans. | February 20, 2025 |
Capsid Inhibitor Capsid inhibitors are a class of drugs that interfere with HIV capsid, a protein shell that protects HIV’s genetic material and enzymes needed for replication. Capsid inhibitors can disrupt HIV capsid during multiple stages of the viral life cycle. | ||||
Lenacapavir (LEN) Sunlenca | LEN (Sunlenca)
| Pregnancy
Dosing in Pregnancy
Standard Adult Doses
Initiation Option 2
Maintenance Dosing
| No human data are available regarding placental or breast milk. Data are insufficient to assess for teratogenicity in humans. No evidence of teratogenicity in rats or rabbits. | February 20, 2025 |
INSTIs INSTIs are the viral enzyme that catalyzes the two-step process that inserts HIV DNA into the genome of the host cell. | ||||
Bictegravir/Emtricitabine/ Tenofovir Alafenamide Note: BIC is available only as part of an FDC tablet. | BIC/FTC/TAF (Biktarvy)
| Pregnancy
Dosing in Pregnancy
For guidance about use of combination products in pregnancy, please see the specific sections on other components (i.e., FTC, TAF). Standard Adult Doses
| High placental transfer to fetusb No evidence of human teratogenicity (can rule out twofold increase in overall birth defects) BIC can be taken with food at the same time as any preparation containing iron or calcium—including prenatal vitamins—but should not be administered within 2 hours of these preparations when taken on an empty stomach. BIC can be taken at least 2 hours before or 6 hours after antacids containing aluminum or magnesium. | February 20, 2025 |
Cabotegravir (CAB) Note: CAB and RPV is a two-drug co-packaged product for IM injection. | CAB
CAB and RPV
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
For guidance about the use of combination products in pregnancy, please see the specific sections on other components (i.e., RPV). Standard Adult Doses Oral Lead-in Therapy (Optional)
Changing Dosing Frequency and Managing Missed Doses | No human data are available regarding placental passage. Insufficient data to assess for teratogenicity in humans. No evidence of teratogenicity in rats or rabbits. | February 20, 2025 |
Dolutegravir (DTG) (DTG/3TC) (DTG/RPV) (DTG/ABC/3TC) | DTG (Tivicay)
DTG (Tivicay PD)
DTG film-coated tablets and DTG dispersible tablets are not bioequivalent and are not interchangeable. DTG/3TC (Dovato)
DTG/RPV (Juluca)
DTG/ABC/3TC (Triumeq)
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
For guidance about the use of combination products in pregnancy, please see the specific sections on other components (i.e., ABC, 3TC, RPV). Standard Adult Doses In ARV-Naive or ARV‑Experienced (but INSTI-Naive) Patients
In ARV-Naive or ARV‑Experienced (but INSTI-Naive) Patients Who Are Also Receiving EFV, FPV/r, TPV/r, or Rifampin
In INSTI-Experienced Patients
| High placental transfer to fetusb No evidence of teratogenicity in rats or rabbits. The most recent data from Botswana indicate the prevalence of NTDs in infants born to pregnant women with HIV receiving DTG at conception is no longer statistically different than in those receiving other ARVs. DTG is a Preferred ARV drug for use during pregnancy, irrespective of trimester, and when trying to conceive (see Recommendations for Use of Antiretroviral Drugs During Pregnancy and Table 7). To maximize DTG absorption, doses should not be administered within 2 hours of ingesting any preparation that contains such minerals as iron or calcium, including prenatal vitamins. | February 20, 2025 |
Elvitegravir (EVG) Note: As of October 2017, the single-drug formulation of EVG (Vitekta) is no longer available. (EVG/c/FTC/TAF) Genvoya (EVG/c/FTC/TDF) Stribild | EVG/c/FTC/TAF (Genvoya)
EVG/c/FTC/TDF (Stribild)
| Pregnancy
Dosing in Pregnancy
For guidance about use of combination products in pregnancy, please see the specific sections on other components (i.e., COBI, FTC, TAF). Standard Adult Doses
| Evidence of high placental transfer of EVG and low transfer of COBIb Insufficient data to assess for teratogenicity in humans. No evidence of teratogenicity in rats or rabbits. EVG/c is not recommended for use in pregnancy. If EVG/c is being taken when pregnancy occurs, consider frequent viral load monitoring or switching to a more effective recommended regimen. If a regimen that contains EVG/c is continued during pregnancy, doses should be administered with a meal and should not be administered within 2 hours of ingesting any preparation that contains minerals, such as iron or calcium, including prenatal vitamins. | February 20, 2025 |
Raltegravir (RAL) Isentress Isentress HD | RAL (Isentress) Film-Coated Tablets
Chewable Tablets
RAL (Isentress HD) Film-Coated Tablets
| Pregnancy PK in Pregnancy
Dosing in Pregnancy
Standard Adult Doses In Patients Who Are Not Receiving Rifampin
In Patients Who Are Receiving Rifampin
| High placental transfer to fetusb No evidence of human teratogenicity (can rule out a 1.5-fold increase in overall birth defects). There is a case report of markedly elevated liver transaminases with RAL use in late pregnancy. Severe, potentially life-threatening, and fatal skin reactions and HSRs have been reported in nonpregnant adults. RAL chewable tablets contain phenylalanine. To maximize RAL absorption, doses should not be administered within 2 hours of ingestion of any preparation containing minerals—such as iron or calcium—including prenatal vitamins. | February 20, 2025 |
Pharmacoenhancers Pharmacoenhancers reduce the metabolism of antiretroviral drugs and prolong their presence in plasma, allowing for more convenient dosing regimens. | ||||
Cobicistat (COBI) Tybost (ATV/c) Evotaz (EVG/c/FTC/TAF) Genvoya (DRV/c) Prezcobix (EVG/c/FTC/TDF) Stribild (DRV/c/FTC/TAF) Symtuza | COBI (Tybost) Tablet
ATV/c (Evotaz)
EVG/c/FTC/TAF (Genvoya)
DRV/c (Prezcobix)
EVG/c/FTC/TDF (Stribild)
DRV/c/FTC/TAF (Symtuza)
| Pregnancy
Dosing in Pregnancy:
For guidance about the use of combination products in pregnancy, please see the specific sections on other components (i.e., FTC, TAF, TDF, ATV, DRV, EVG). COBI (Tybost)
ATV/c (Evotaz)
EVG/c/FTC/TAF (Genvoya)
DRV/c (Prezcobix)
EVG/c/FTC/TDF (Stribild)
DRV/c/FTC/TAF (Symtuza)
| Low placental transfer to fetusb No evidence of human teratogenicity (can rule out twofold increase in overall birth defects). Use of COBI-boosted ATV, DRV, or EVG is not recommended in pregnancy. | February 20, 2025 |
Ritonavir (RTV) Norvir (LPV/r) Kaletra | RTV (Norvir)
Tablet
Powder
Oral Solution
| Pregnancy
RTV Dosing in Pregnancy
LPV/r Dosing in Pregnancy
For guidance about use of combination products in pregnancy, please see the specific sections on other components (i.e., LPV/r).
Tablet
Capsule or Powder
Standard Adult Doses of LPV/r (Kaletra)
Tablet
Oral Solution
With EFV or NVP in PI-Naive or PI-Experienced Patients
| Low placental transfer to fetusb No evidence of increased risk of human teratogenicity (can rule out 1.5-fold increase in overall birth defects). RTV should only be used as a low-dose booster for other PIs. LPV/r oral solution contains 42% alcohol and 15% propylene glycol and is not recommended for use in pregnancy. Once-daily LPV/r dosing is not recommended during pregnancy. | February 20, 2025 |
a Individual ARV drug doses may need to be adjusted in patients with renal or hepatic insufficiency (for details, see the Adult and Adolescent Antiretroviral Guidelines, Appendix B). High: >0.6 d As of June 2023, Atripla brand products are no longer available. |