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3 Weeks pregnant on Atripla
Feb 19, 2014

Dear Mr. Young,

I just found out that I am 3 weeks pregnant while on Atripla. I just read your response to another woman, saying that the risk of malformation from Atripla is low. However, the general consens in the internet seems to be that there is a serious risk of malformation or other problems after birth. Why this discrepancy? I would like to abort this week, to avoid any risk of having an abnormal baby (Atripla-related), but all this contradicting information is not helping me. Would Atripla be a serious risk for a baby or would it not? Could there also be disabilities other than neural tube defects, which could only be found out after birth?

Please help

Response from Dr. Young

Hello and thanks for posting your important question.

There is a very small risk of birth defects with efavirenz (part of Atripla). Here in the US, we generally don't recommend using efavirenz during the first trimester, but the US Department of Health and Human Services Panel (a group of really smart people) have recently summarized the situation:

HIV-infected women who become pregnant while their virus is controlled on an efavirenz-containing regimen may now continue that regimen, rather than switching from efavirenz and risking virologic failure. This new recommendation is based on the fact that a switch from efavirenz during pregnancy probably occurs too late to counter the main risk of the drug neural tube defects, which typically occur during the first 6 weeks of pregnancy, before most women are even aware they are pregnant. - See more at: http://www.jwatch.org/ac201208300000001/2012/08/30/revised-dhhs-guidelines-perinatal-antiretroviral#sthash.GOUWZsWK.dpuf

Many women do indeed get pregnant while taking efavirenz and there isn't an epidemic of related birth defects. Indeed, outside of this country and especially in sub-Saharan Africa, this issue is not of great concern.

I'd suggest speaking to your care provider, or a pediatric HIV specialist (here in Colorado, we have a whole team of people devoted to the care of pregnant women at The Children's Hospital, Denver).

I know this doesn't give you a concrete answer, but I hope the information is helpful. BY



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