Adverse perinatal outcomes associated with prenatal exposure to protease-inhibitor-based versus non-nucleoside reverse transcriptase inhibitor-based antiretroviral combinations in pregnant women with HIV infection: a systematic review and meta-analysis

Care of the Child Perinatally Exposed to Human Immunodeficiency Virus

Substantial progress in preventing vertical human immunodeficiency virus (HIV) transmission has led to a dramatic decline in new pediatric HIV infections. Alongside this success, a growing population of children who are HIV-exposed but uninfected face unique health challenges due to a variety of risk factors. Recommendations for healthcare providers caring for this population include optimizing and integrating general and HIV-related care for both mother and child through comprehensive care packages. Further research and multidisciplinary approaches are needed to address the long-term health implications for this vulnerable population.

Antiretroviral Therapy in Pregnancy: A 2023 Review of the Literature

PURPOSE OF REVIEW

Selection of antiretroviral therapy during pregnancy must consider maternal physiology and resulting pharmacokinetic changes in pregnancy, resistance and efficacy profiles, tolerability and frequency of adverse effects, teratogenicity, and maternal, neonatal, and pregnancy outcomes. The objective of this review is to summarize the underlying data that informs the current clinical perinatal guidelines in the USA.

RECENT FINDINGS

Data now supports the use of dolutegravir at all stages of pregnancy with no significant increase in neural tube defects. Safety and pharmacokinetic data on newer antiretroviral medications in pregnancy continue to lag behind the general population. While there are multiple safety and tolerability concerns with older regimens, there are now multiple options of regimens that are highly efficacious and have good safety data in pregnancy. Most pregnant patients who are virally suppressed on a well-tolerated regimen are able to safely continue those medications during pregnancy.