Of the 1.3 million persons living with human immunodeficiency virus (HIV) who become pregnant each year worldwide, approximately 1.1 million (85%) receive antiretroviral therapy (ART) during pregnancy, authors of a review article report. Most of these people live in low- and middle-income countries where ART is often unavailable. This leads to infants acquiring HIV antenatally, perinatally, or during breastfeeding. ART is strongly recommended before and during pregnancy, but questions remain as to which regimen is optimal in terms of efficacy and safety.
Based on the evidence presented in the article, the authors conclude: “The known benefits of ART in pregnant persons living with HIV for optimizing maternal and infant health and preventing transmission of HIV to the infant clearly outweigh potential adverse outcomes. Newer ART regimens are associated with better pregnancy outcomes than the older antiretroviral agents. For these reasons, pregnant persons should start or continue treatment with preferred or alternative ART regimens that result in adequate viral suppression and are associated with an acceptable adverse-effect profile. The data on most of the newer ART regimens remain reassuring, but pharmacovigilance should be maintained. Although there are no particular concerns, current data on the safety of darunavir–ritonavir during pregnancy are limited, and pharmacokinetic and safety data for bictegravir, doravirine, and the recently licensed long-acting injectable agents cabotegravir and rilpivirine are even more limited. Earlier (including prelicensure) pharmacokinetic and limited safety studies of new antiretroviral agents during pregnancy are needed, so that patients and providers do not have to wait years for sufficient data to inform their use of new HIV drugs during pregnancy. In the meantime, clinicians should continue to monitor pregnant persons living with HIV for potential pregnancy complications and manage their care and the care of their babies.”