HIV and Pregnancy

Safety of Anti-HIV Medications During Pregnancy

I am HIV infected and pregnant. Is it safe to use anti-HIV medications during my pregnancy?

Women infected with HIV can safely use many anti-HIV medications during pregnancy to protect their health and to prevent transmitting HIV to their babies. However, some anti-HIV medications can cause problems when used during pregnancy. Knowing more about the safety of anti-HIV medications and pregnancy will help you and your health care provider decide what medications are right for you.

Is my baby at risk from anti-HIV medications I take during pregnancy?

It's not known if babies will have any long-term effects from the anti-HIV medications their mothers use during pregnancy. However, the risk of mother-to-child transmission of HIV is known. And the illness that results when HIV infection is passed from a mother to her child is very real. Because anti-HIV medications can greatly reduce the risk of passing HIV infection from a mother to her child during pregnancy, all pregnant women infected with HIV should take anti-HIV medications.

Information on the use of anti-HIV medications during pregnancy is limited. But enough information is known to make recommendations about the safety of the most commonly used medications from the three most commonly used classes of anti-HIV medications -- protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and nucleoside reverse transcriptase inhibitors (NRTIs). (Not enough information is known to make recommendations about use during pregnancy of entry inhibitors and integrase inhibitors, two additional classes of anti-HIV medications.)

Protease inhibitors (PIs)

There may be a link between the use of some PIs and high blood sugar (hyperglycemia) or diabetes. For some women, the risk of hyperglycemia increases in pregnancy. It is unclear if taking PIs adds to this risk. Talk to your health care provider about the use of PIs during pregnancy and about when to have blood tests to check for hyperglycemia or diabetes.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Two NNRTIs, Sustiva and Viramune, should be used in pregnant women only under certain conditions.

• Sustiva may cause birth defects that develop during the first few months of pregnancy. Therefore, if possible, use of Sustiva should be avoided in the first trimester of pregnancy. Atripla, a combination pill that contains Sustiva, should also be avoided in the first trimester of pregnancy. After the first trimester, Sustiva or Atripla can be used safely.
• Viramune increases the risk of very serious liver damage in women with CD4 counts greater than 250 cells/mm³. Viramune should only be started in pregnant women with CD4 counts higher than 250 cells/mm³ if the benefits very clearly outweigh the risks. Women who begin using Viramune during pregnancy are carefully monitored for early signs of liver damage. Women taking Viramune without problems before they become pregnant can safely continue to take the medication. Liver damage from Viramune use in pregnancy has not been seen in women already taking the medication without side effects.

Nucleoside reverse transcriptase inhibitors (NRTIs)

Using NRTIs can sometimes lead to lactic acidosis, a condition caused by the buildup of a specific acid in the blood. Women should not take the combination of Zerit and Videx during pregnancy because the combination has caused deaths from lactic acidosis and liver failure. Women taking NRTIs during pregnancy are watched carefully for signs of lactic acidosis.

Talk to your health care provider about the safety of anti-HIV medications during pregnancy. There are many anti-HIV medications to choose from that will keep you and your baby healthy.

For More Information

Contact an AIDSinfo health information specialist at 1-800-448-0440 or http://aidsinfo.nih.gov. See your health care provider for medical advice.

This information is based on the U.S. Department of Health and Human Services' Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States (available at http://aidsinfo.nih.gov/guidelines/).