TABLE 8.

Drug safety in pregnancy.

Drug	Comment
Tenofovir (TDF)	High placental transfer. No evidence of human teratogenicity. All have anti-HBV activity, therefore risk of hepatitis flare if stopped.
Emtricitabine (FTC)
Lamivudine (3TC)
Stavudine (d4T)	High placental transfer. No evidence of human teratogenicity.
	Do not use with ddI (risk of lactic acidosis) or AZT (both thymidine analogues).
Zidovudine (AZT)	High placental transfer. No evidence of human teratogenicity.
	Do not use with d4T (both thymidine analogues).
Raltegravir (RAL)	High placental transfer. Insufficient data to assess human teratogenicity.
	Case report of markedly elevated liver transaminases in late pregnancy.
Dolutegravir (DTG)	Unknown placental transfer. Insufficient data to assess human teratogenicity.
	No data on use in pregnancy.
Atazanavir (ATV)	Low placental transfer. No evidence of human teratogenicity.
	Increased dosing in T2/3?
	Non-pathologic neonatal hyperbilirubinaemia.
Lopinavir (LPV)	Low placental transfer. No evidence of human teratogenicity.
	Once daily dosing not advised during pregnancy.
	Avoid oral solution owing to alcohol and propylene glycol content.
Darunavir (DRV)	Low placental transfer. Insufficient data to assess human teratogenicity.
	Less experience in pregnancy than LPV/r and ATV/r.
Ritonavir (RTV)	Low placental transfer. No evidence of human teratogenicity.
	Not used for antiretroviral effect, but in lower doses as PI booster in combination with other PIs.
	Avoid oral solution owing to alcohol content.
Efavirenz (EFV)	Moderate placental transfer.
	Potential foetal safety concerns. No increase in overall birth defects with T1 exposure in humans.

HBV, hepatitis B virus; ddI, didanosine; T2/3, trimester 2/3; PI, protease inhibitor.