US perinatal guidelines updated (2006)

On October 12, the Public Health Service Task Force updated its Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States.

Methergine should not be co-administered with drugs that are potent CYP3A4 enzyme inhibitors, including protease inhibitors and the NNRTIs efavirenz and delavirdine….

An update on preconceptual counseling and care for HIV-1-infected women of childbearing age.

It is recommended that all women of child-bearing age are offered the opportunity to receive preconception counseling and care as a component of routine primary medical care.

Lopinavir/r (Kaletra) was added as a first-line preferred PI in HIV+ women who are pregnant; prior to this update nelfinavir (Viracept) was the only preferred PI.

There is an update on abacavir; in Table 3, pharmacokinetics are not significantly altered in pregnancy; no change in dose is indicated. The Guidelines are updated with information on the use of Darunavir (TMC114). In addition, there is an update on Kaletra: in Table 3, pharmacokinetic studies of standard dose of lopinavir/ritonavir capsules a (3 capsules twice daily) during 3rd trimester indicated levels were significantly lower than during postpartum period and in non-pregnant adults; an increased dose of 4 capsules of lopinavir/ritonavir twice daily starting in the 3rd trimester resulted in adequate lopinavir exposure; by 2 weeks postpartum, standard dosing was again appropriate. Pharmacokinetic studies of the new lopinavir/ritonavir tablet formulation are underway, but data are not yet available. And there is additional information in the Guidelines.