2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Initial ART Regimens for ARV-Naïve Pregnant Women (December 2019)

Preferred

NRTI backbone:ABC/3TC or TDF/FTC or TDF/3TC

INSTI:DTG/ABC/3TC orDTG + preferred2-NRTI backbone;orRAL+ preferred2-NRTIbackbone

PI:ATV/r + preferred2-NRTIbackboneor DRV/r+ preferred2-NRTIbackbone

Alternative

NRTIbackbone: ZDV/3TC

PI: LPV/r+preferred 2-NRTIbackbone

NNRTI:EFV/TDF/FTCor EFV/TDF/3TCor EFV + preferred 2-NRTIbackbone; or RPV/TDF/FTCor RPV+ preferred 2-NRTIbackbone

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Initial ART Regimens for ARV-Naïve Pregnant Women

InsufficientData

BIC/TAF/FTC; DOR; IBA;TAF/FTC; RPV/TAF/FTC

DoNot Use

Not recommended in pregnancy due to concerns about maternalor fetal safetyor inferior efficacy: ATV/COBI; DRV/COBI;DRV/COBI/FTC/TAF; EVG/COBI/FTC/TDF:EVG/COBI/FTC/TAF Not recommended in ARV-naïve pregnant women due to limited dataon PK, safetyand efficacy: MVC;ETR; NVP (potential for adverse events, low resistancebarrier); T-20 Not recommended in pregnancy: ddI; d4T; FPV; FPV/r; IDV; IDV/r;NFV; RTV; SQV;SQV/r;TPV; TPV/r; DTG/RPV;ABC/3TC/ZDV

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Table 7.Situation-SpecificRecommendations forUseofAntiretroviralDrugs inPregnant Women andNonpregnantWomenWhoAreTrying toConceive a

ART forPregnantWomen WhoHaveNeverReceived ARVDrugsandWhoAre InitiatingART for theFirst Time

ContinuingARTforWomen WhoBecomePregnantonan ARTRegimen thathasbeen WellToleratedand Virologically Suppressive

ART forPregnantWomen WhoHaveReceivedARV Drugs in thePastandWho AreRestartingART b

NewART Regimen forPregnant WomenWhoseCurrentART isnot WellToleratedand/or isnot Resulting inVirologicSuppression b

ARTRegimenComponent

ART forNonpregnant WomenWhoAreTrying toConceive b,c

INSTIs Used in combinationwithadual-NRTIbackbone d DTG Preferred e

Continue e

Preferred e

Preferred e

Alternative e

RAL

Preferred

Continue

Preferred

Preferred

Preferred

BIC

Insufficientdata

Insufficientdata

Insufficientdata

Insufficientdata

Insufficientdata

Not recommended f

Not recommended f

Not recommended f

Not recommended f

EVG/COBI

Consider switch,or continue with frequent viral load monitoring f

PIs Used in combinationwithadual-NRTIbackbone d ATV/r Preferred

Continue

Preferred

Preferred

Preferred

DRV/r

Preferred

Continue

Preferred

Preferred

Preferred

LPV/r

Alternative

Continue

Alternative

Alternative

Alternative

Not recommended f

Not recommended f

Not recommended f

Not recommended f

ATV/COBI

Consider altering the regimen, or continuing thesame regimenwith frequent viral loadmonitoring f

Not recommended f

Not recommended f

Not recommended f

Not recommended f

DRV/COBI

Consider altering the regimen, or continuing thesame regimenwith frequent viral loadmonitoring f

NNRTIs Used in combinationwithadual-NRTIbackbone d EFV Alternative

Continue

Alternative

Alternative

Alternative

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