Strategies for HIV therapy

April 2008    View PDF    En español

Pregnant women and therapy

In general, the guidelines for treating pregnant women are the same as for treating non-pregnant adults. The decisions to start, change or add HIV drugs should be based on CD4+ counts and disease stage. The strategies presented in this publication are all valid for pregnant women. The Federal Guidelines recommend that women get the most effective HIV therapy regardless of pregnancy status.

However, how therapy affects an infant or unborn child is not wholly known. Therefore, deciding to use HIV therapy during pregnancy should be made by the woman considering the known and unknown benefits and risks to her and her child. Long-term follow-up is recommended for all infants born to women taking HIV therapy during their pregnancies. Some drugs are not recommended because they cause birth defects either in humans or animals, called Category C and D drugs.

Women in their first trimester (14 weeks) who don’t take HIV therapy may decide to delay therapy until after 10–12 weeks because of the possible risks to the developing fetus during that time. However, if a woman’s health warrants starting therapy sooner, most would recommend starting it regardless of how far along a woman is.

A woman already on therapy may consider temporarily stopping it until after her first trimester. While there are no clear data on how HIV drugs affect a developing fetus, most doctors recommend staying on a potent regimen regardless of how far along she is in her pregnancy. Stopping or delaying therapy may increase HIV levels — possibly increasing her risk of disease progression as well as the risk of passing HIV onto her child.

Nevertheless, if a woman decides to stop her therapy, all drugs (except Viramune) should be stopped at the same time to prevent drug resistance. Similarly, they should be restarted at the same time. Using Sustiva is strongly discouraged, especially during the first trimester, due to possible harmful effects on the unborn child. Viracept (nelfinavir) is also not recommended. For more information, read Project Inform’s publication, Pregnancy and HIV.