Clinical Manual for Management of the HIV-Infected ... - myCME.com

Section 3—Antiretroviral Therapy | 3–27
Table 2. Antiretroviral Drug Use in Pregnant HIV-Infected Women: Pharmacokinetics, Toxicity Data, and Recommendations
Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors
Antiretroviral Drug Pharmacokinetics during Pregnancy Concerns during Pregnancy Rationale for Recommended
Use during Pregnancy
NRTI class concerns and
comments
Recommended Agents
Zidovudine
(Retrovir, AZT, ZDV)
Lamivudine
(Epivir, 3TC)
Alternative Agents
Didanosine
(Videx, ddI)
Emtricitabine
(Emtriva, FTC)
Stavudine
(Zerit, d4T)
Abacavir
(Ziagen, ABC)
Insufficient Data to Recommend Use
Tenofovir DF
(Viread)
Not Recommended
Zalcitabine
(Hivid, ddC)
Note: zalcitabine has
been discontinued by the
manufacturer.
Pharmacokinetics not significantly
altered in pregnancy; no change in
dose indicated.
Pharmacokinetics not significantly
altered in pregnancy; no change in
dose indicated.
Pharmacokinetics not significantly
altered in pregnancy; no change in
dose indicated.
See text for discussion of potential maternal
and infant mitochondrial toxicity.
No evidence of human teratogenicity. Welltolerated,
short-term safety demonstrated for
mother and infant.
No evidence of human teratogenicity. Welltolerated,
short-term safety demonstrated for
mother and infant.
Cases of lactic acidosis, some fatal, have
been reported in pregnant women receiving
didanosine and stavudine together.
NRTIs are recommended for use as part of
combination regimens, usually including 2 NRTIs with
either an NNRTI or 1 or more PIs. Use of single or dual
NRTIs alone is not recommended for treatment of
HIV infection (zidovudine alone may be considered
for prophylaxis of perinatal transmission in pregnant
women with HIV RNA