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Review
. 2024 Nov 1;19(6):305-315.
doi: 10.1097/COH.0000000000000884. Epub 2024 Sep 20.

Current opinion: antiretrovirals during pregnancy and breastfeeding

Laura Nijboer  1 , Lena van der Wekken-Pas  1 , Karoline Aebi-Popp  2   3 , Elisabeth van Leeuwen  4 , Angela Colbers  1
Affiliations
Review

Current opinion: antiretrovirals during pregnancy and breastfeeding

Laura Nijboer et al. Curr Opin HIV AIDS. .

Abstract

Purpose of review: To review the most important literature from the past 2 years on the pharmacokinetics of antiretrovirals in pregnancy, placental transfer, and breastmilk.

Recent findings: Concentrations of antiretrovirals frequently used in pregnancy and their placental transfer are described, together with infant exposure through breastmilk. Also, applications of ex-vivo and in-silico studies, such as placenta perfusion studies and PBPK models, are discussed.

Summary: Great efforts were made in the past 2 years to accelerate the availability of data on antiretrovirals during pregnancy and lactation. Bictegravir showed decreased but still sufficient concentrations during pregnancy, leading to a label change by the FDA. In-silico and clinical studies on long-acting cabotegravir and rilpivirine generated information leading to cautious use of these formulations in pregnancy. Low infant exposure to antiretrovirals through breastmilk is expected for most compounds. Despite the impact of these studies, more incentives are needed for earlier implementation, for instance, during the developmental phase of drugs, to provide women antenatally with proper information on their drugs.

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Conflict of interest statement

A.C. received research grants from ViiV Healthcare, Gilead, Merck, all paid to the institution. K.A.P. s institution received grants from Gilead and ViiV healthcare. L.N., L.v.d.W., and E.v.L. have no conflict of interest to report.

Figures

Box 1
Box 1
no caption available
FIGURE 1
FIGURE 1
Ratio of area under the curve and Ctrough in third trimester/postpartum. (∗) Unbound drug; (+) Clast.
FIGURE 2
FIGURE 2
Cord blood/maternal plasma ratio. (∗) Unbound drug.
FIGURE 3
FIGURE 3
Breastmilk/maternal plasma ratio and relative infant dose.
See this image and copyright information in PMC

References

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