The Use of Antiretroviral Drugs in Pregnancy

THE USE OF ANTIRETROVIRAL DRUGS IN PREGNANCY

Zidovudine was the first agent to be used to prevent the transmission of HIV from a pregnant woman to her child. It was given to the mother at 14 to 34 weeks’ ges-tation and to the child for the first 6 weeks of life. Current combination therapies employ zidovudine with another NRTI and a protease inhibitor.

The teratogenic risk associated with administration of antiretroviral drugs during the first trimester of pregnancy is not clear. Women who have not begun therapy prior to becoming pregnant may consider waiting until after 10 to 12 weeks’ gestation to begin antiviral treatment. If a woman decides to discontinue antiretroviral therapy dur-ing pregnancy, all drugs should be stopped and reintro-duced simultaneously to avoid the development of resist-ance. Pregnant women may be particularly susceptible to hyperglycemia caused by protease inhibitors.

In the United States, the Centers for Disease Control recommend that HIV-infected mothers avoid breast-feeding to prevent the transmission of the virus to their infants. The risk of this type of vertical trans-mission ranges from 5 to 20%; longer durations of breast-feeding, mastitis, and abscesses are associated with increased risk. In developing countries in which safe infant formula is not readily available, the avoid-ance of breast-feeding can increase the infant’s risk of death from malnutrition and food-borne infection. The World Health Organization recommends that under these circumstances exclusive breast-feeding should be maintained for the first months of life and discontinued when replacement feeding is acceptable, feasible, af-fordable, sustainable, and safe.