ART Selection in Women of Childbearing Age and During Pregnancy

In summary, there are special considerations for prescribing ART to women of childbearing age related to safety in pregnancy, changes in PKs during pregnancy, and drug–drug interactions between some ARV agents and some hormonal contraceptive methods. Based on the available evidence at the time of the most recent DHHS guideline update suggesting a possible small increase in NTDs in women who conceive while receiving DTG-based regimens, DTG is considered an alternative ARV agent for women trying to conceive and a preferred agent throughout pregnancy. In most cases, DTG should be continued when a woman presents to care on DTG in the first trimester. By contrast, RAL remains a preferred ARV agent both during pregnancy and for women trying to conceive.

Finally, PK issues with some ARV drugs during pregnancy may warrant an increase in dose, particularly in later pregnancy, or closer HIV-1 RNA monitoring.