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Antiretroviral Therapy in Pregnancy: A 2023 Review of the Literature

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Abstract

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.

Summary

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.

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Data Availability

There is no primary data for this paper.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA

    Alison N. Goulding, Lena Shay & Jennifer McKinney

  2. School of Medicine, Saint Louis University, Saint Louis, MO, USA

    Kasey Meeks

  3. School of Medicine, Baylor College of Medicine, Houston, TX, USA

    Sarah Casey

  4. School of Medicine, University of California San Diego, San Diego, CA, USA

    Colton Applegarth

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  1. Alison N. Goulding
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  6. Jennifer McKinney
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All authors wrote and edited the main manuscript text. All authors reviewed the manuscript

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Correspondence to Jennifer McKinney.

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Goulding, A.N., Meeks, K., Shay, L. et al. Antiretroviral Therapy in Pregnancy: A 2023 Review of the Literature. Curr HIV/AIDS Rep 21, 1–10 (2024). https://doi.org/10.1007/s11904-024-00688-y

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