US pregnancy guidelines updated (2009)

Revisions to the July 2008 version of the US guidelines for use of antiretrovirals during pregnancy, are usefully highlighted in yellow in the new PDF document, and include:

  • A new brief discussion of recent trials on the use of antiretroviral drugs for prevention of mother-to-child HIV transmission through breastfeeding, with addition of these trials to Table 1. The Panel reaffirms that in the United States, where safe, affordable and feasible alternatives are available and culturally acceptable, breastfeeding is not recommended for HIV-infected women (including those receiving HAART).
  • A more detailed discussion of duration of infant ZDV prophylaxis is provided. The Panel reaffirms the recommendation for administration of the standard six week course of infant prophylaxis unless there are concerns about adherence or toxicity; in such cases, consideration may be given to reducing the duration of infant prophylaxis from six to four weeks.
  • Information regarding animal carcinogenicity and teratogenicity studies have been added to Table 2, as well as information on the new drug etravirine.
  • Table 3 has been revised to reflect new information on antiretroviral drug pharmacokinetics in pregnancy and add information and recommendations regarding the use of etravirine. Additionally, atazanavir is now listed as an “Alternative” drug for use in pregnancy, and tenofovir and efavirenz are now listed in the category of “Use in Special Circumstances”.
  • Updated information on preclinical animal studies and the Antiretoviral Pregnancy Registry and new data from recent pharmacokinetic studies in pregnancy are provided.


Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States – April 29, 2009 Guidelines/GuidelineDetail.aspx?MenuItem=Guidelines&Search=Off&GuidelineID=9&ClassID=2

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