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Class ⬇

Antiviral (HIV-1 and HBV)

PREGNANCY RECOMMENDATION:Human Data Suggest Low Risk (Maternal Benefit May Outweigh Embryofetal Risk—for Both HIV and HBV)

BREASTFEEDING RECOMMENDATION:*Contraindicated (HIV)—Probably Compatible (HBV)

Pregnancy Summary ⬆ ⬇

In 2023, the updated US Department of Health and Human Services AIDS Info guidelines for the use of antiretroviral agents during pregnancy recommend that, in most cases, patients continue their regimen during pregnancy if it is tolerated, safe, and effective in suppressing viral replication. Additionally, treatment initiation should not be delayed due to concerns about teratogenicity with first-trimester exposure. See the guideline for the most updated information. If indicated, lamivudine should not be withheld in pregnancy since the expected benefit to the mother with HIV outweighs the unknown risk to the fetus. The same applies to the product used for treating hepatitis B. The data regarding first-trimester exposure to lamivudine is not associated with an increased risk of congenital anomalies or adverse infant outcomes. For HIV, there is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antiretrovirals during pregnancy. Health care providers are encouraged to register patients by calling the Antiretroviral Pregnancy Registry (APR) at 1-800-258-4263.

Breastfeeding Summary ⬆ ⬇

In 2023, the updated US Department of Health and Human Services AIDS Info guidelines state that using replacement of breast milk through formula or pasteurized donor human breast milk from a milk bank eliminates the risk of postnatal HIV transmission to the infant. Using antiretroviral therapy to achieve and maintain viral suppression during pregnancy and postpartum decreases the risk for infant transmission to less than 1%, but not zero. *For patients not on therapy or those without viral load suppression during pregnancy (at a minimum of throughout the third trimester) and at delivery, replacement of breast milk is recommended. Patients on antiretroviral therapy who have a sustained undetectable viral load and who choose to breastfeed or use replacement of breast milk should be supported with this decision. Using lamivudine in treating hepatitis B virus (HBV) during lactation should be compatible. If used while breastfeeding, the infant should be monitored for the most common reported pediatric side effects of fever and cough.

Reference ⬆

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  5. Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral pregnancy registry interim report for 1 January 1989 through 31 July 2023. Registry Coordinating Center; 2023. Accessed January 26, 2024. https://www.apregistry.com/forms/interim_report.pdf
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