Table 3.
Pregnancy outcomes of individual antiretroviral agents during pregnancy∗.
| Brand name | Reported adverse pregnancy outcomes | |
|---|---|---|
| Maternal | Fetal/neonatal | |
| NRTI | ||
| Zidovudine | Potential for hematologic toxicities (anemia and bone marrow suppression) [52], including elevated liver function tests [53], myelotoxicity [54], acute pancreatitis [54], preeclampsia, and other hypertensive disorders [55] | PTD [37], SGA [37], LBW [37], and CHD [35] |
| Tenofovir disoproxil fumarate | Kidney [56] and bone toxicity [57] | Decreased bone mineral density content [58] |
|
| ||
| NNRTI | ||
| Efavirenz | Rash and drug interactions [59] | Initial concern of birth defects seen in primate study [60]; however, recent studies have not shown an increased risk of neural tube defects [61] |
| Abacavir | Abacavir should not be used in patients who test positive for HLA-B∗5701 because a positive test may increase the risk of a hypersensitivity reaction [56], nausea, vomiting, diarrhea, and abdominal pain [59] | None |
| Didanosine | Pancreatitis (acute and chronic) [54] and neuropathy | Initial studies concerning for an association with fetal anomalies, specifically head and neck anomalies when exposed during the first trimester [35]; however, recent studies found no adverse outcomes [62] |
| Nevirapine | 10-fold increased risk of hepatotoxicity¥ [63, 64] | No reported fetal malformations [64] |
| Emtricitabine | Headache, nausea, vomiting, and diarrhea [59] | None [65] |
|
| ||
| Protease inhibitors | ||
| Ritonavir | Nausea, vomiting, increased triglycerides, and transaminases [59] | |
| Atazanavir | Abdominal pain, diarrhea, nausea, and increased liver function tests [59] | PTD [31, 32, 34, 66] |
| Lopinavir | Nausea, vomiting, diarrhea, and pancreatitis [59] | PTD [21, 31, 34, 66] |
| Darunavir | Maternal hyperbilirubinemia and nausea [59] | PTD [31, 32, 34, 66] |
∗Table provides a short list of the updated ARV's and their reported safety issues.
¥Nevirapine can cause fatal and severe hepatotoxicity among women with CD4 lymphocytes > 250 cells/μL.
NRTI: nucleoside or nucleotide reverse transcriptase inhibitor, NNRTI: nonnucleoside or nonnucleotide reverse transcriptase inhibitor, PTD: preterm delivery (delivery prior to 37 weeks), SGA: small for gestational age (birth weight less than the 10th percentile for their gestational age), LBW: low birth weight (birth weight less than 2500 grams), and CHD: congenital heart defects.