Complications
Antiretroviral therapy (ART) exposure in utero may have long-term effects in children, including organ system toxicities and neoplasia; however, available evidence does not permit definitive conclusions about this risk. The data gathered over the past two decades are reassuring, particularly in relation to zidovudine exposure. Further study is required. Children who develop significant organ system abnormalities after exposure to ART, particularly those of the nervous system or heart, should be evaluated for mitochondrial dysfunction.[7]
Perinatal transmission of the virus, from mother to child, can occur throughout pregnancy, during labour and delivery, and postnatally through breast milk.
Increased utilisation of antiretroviral therapy (ART) during pregnancy has led to a dramatic decrease in perinatal transmission. Untreated, the risk of perinatal transmission of HIV is between 15% and 45%, but can be lowered to 1% or less with a combination of preventive measures including ART for mothers and prophylaxis for neonates.[6][7]
Antiretroviral therapy (ART) during pregnancy does not generally increase the risk of birth defects, based on multiple studies indicating no difference in rates of total birth defects for first-trimester exposure compared with later drug exposures. However, data on the risks of birth defects for many drugs are limited and evolving.[7]
Drugs for which sufficient numbers of first trimester exposures have been monitored to detect at least a two-fold increase in the risk of overall birth defects, and no such increases were detected: cobicistat, darunavir, didanosine, dolutegravir, elvitegravir, indinavir, raltegravir, rilpivirine, stavudine, tenofovir alafenamide.[7]
Drugs for which sufficient numbers of first trimester exposures have been monitored to detect at least a 1.5-fold increase in the risk of overall birth defects and no such increases were detected: abacavir, atazanavir, efavirenz, emtricitabine, lamivudine, lopinavir/ritonavir, nelfinavir, nevirapine, ritonavir, tenofovir disoproxil, zidovudine.[7]
Drugs for which insufficient numbers of exposures have been reported to assess the level of risk: bictegravir, cabotegravir, doravirine, enfuvirtide, etravirine, fostemsavir.[7]
Consult a specialist, or a specialist drug information service, for further guidance on the most current safety information on specific antiretroviral drugs.
Studies have found conflicting data on the association between antiretroviral therapy (ART) and increased risk of preterm birth.[79][80][81][82][83][84][85][86] Given these conflicting data, no changes in ART are indicated in pregnancy.
Several studies have found increased preterm birth rates in women with HIV on no antiretroviral therapy, especially with more advanced disease.[93][94][95]
The data regarding the effect of ART on birth weight are mixed, and data related to ART and stillbirth are limited.[7]
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