Antiretroviral treatment in pregnancy

Abstract

Purpose of review: With combination antiretroviral therapy, perinatal HIV transmission can be decreased to less than 1%. With this remarkable success, in areas with adequate resources, attention has now been turned to the safety of these medications for the mother and the fetus. This review will discuss relevant publications, from the past year, regarding safety and pharmacokinetics, particularly pertaining to the resource-rich setting.

Recent findings: Studies are in disagreement about an association between antiretrovirals and prematurity and other adverse pregnancy outcomes. The pharmacokinetics of some antiretroviral medications are altered significantly during pregnancy, while others appear unchanged. Placental transfer to the fetus is variable. Reports about mitochondrial toxicity in the infant provide conflicting conclusions. Potential toxicities in both the mother and fetus are areas of concern.

Summary: While the well documented benefit in preventing mother-to-child transmission generally outweighs the potential risks to the fetus, infant and mother, there are legitimate concerns. Clinicians providing care to HIV-infected pregnant women must have a thorough understanding of these potential complications. More data on the safety and pharmacokinetics of antiretrovirals during pregnancy are needed.