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HIV treatment during pregnancy
Sep 7, 2000

What drugs have been used safely during pregnancy?

I just found out I'm expecting while on a combo of Viracept, 3tc, abacavir, and zerit (I haven't been taking the zerit for a few weeks, because I ran out) My Dr. hasn't had anyone on abacavir before. Do you have any information that will be helpful? It's been three weeks since conception. Thanks for a great service!

Response from Dr. Luzuriaga

Of all the antiretrovirals, we have the most experience with zidovudine (ZDV or AZT) in pregnancy. ZDV appears to be generally well-tolerated by moms and babies. Low red blood cell count (anemia) was the most frequently encountered short-term toxicity in the babies -- this was reversible when the ZDV therapy was stopped. Because of ZDV's track record in preventing transmission of the virus from mom to baby, most experts would recommend that ZDV be included in a pregnant woman's regimen, if possible. However, the findings that other drugs (e.g., nevirapine) can prevent vertical transmission and the finding that transmission of the virus is very unusual when women's viral loads are undetectable, makes many experts comfortable with other combination regimens.

We have less experience with the other antiretrovirals, but that experience is growing as the number of HIV positive women receiving multi-drug regimens increases. DDI, nevirapine, d4T,3TC, and viracept are the most commonly prescribed antiretrovirals after ZDV during pregnancy and all have favorable toxicity and activity profiles. We have less data for abacavir; all patients on abacavir should be aware of the potential for the hypersensitivity syndrome (fever, rash, fatigue, abdominal symptoms) and stop the drug immediately (and contact their care provider) if these symptoms occur. The only antiretroviral that is not recommended for use in pregnancy is efavirenz because of birth defects in baby monkeys whose mothers took the drug during pregnancy. Because both pregnancy and protease inhibitor therapy might increase the possibility of glucose intolerance (sugar diabetes), women on protease inhibitors should be monitored closely for this. For a complete discussion concerning the use of antiretrovirals during pregnancy, please see "Guidelines for the Use of Antiretrovirals During Pregnancy" (February 25, 2000), available on the guidelines page of this web site (www.thebody.com/treat/guidelines.html).

KL


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