Preferred antiretroviral agents for treatment-naïve pregnant individuals with HIV in resource-rich settings

	Considerations
Dual NRTI backbone
Tenofovir alafenamide-emtricitabine or Tenofovir alafenamide plus lamivudine	Tenofovir alafenamide-emtricitabine is available as a fixed-dose combination Once-daily administration
Tenofovir disoproxil fumarate-emtricitabine or Tenofovir disoproxil fumarate-lamivudine	Tenofovir disoproxil fumarate-emtricitabine and tenofovir disoproxil fumarate-lamivudine* are available as fixed-dose combinations Once-daily administration Tenofovir disoproxil fumarate has potential for renal toxicity; these combinations should be used with caution in patients with renal insufficiency
Abacavir-lamivudine	Available as a fixed-dose combination Once-daily administration HLA-B5701 testing is required prior to use; abacavir should not be used in patients who test positive because of the risk of a hypersensitivity reaction Not recommended if pre-treatment HIV RNA level >100,000 copies/mL
Third drug – Integrase inhibitor
Dolutegravir	Rapid viral load reduction; preferred for women presenting late in pregnancy, with high viral load, or with acute HIV Useful when drug interactions with protease inhibitor regimens are a concern Well tolerated Once-daily administration Available as a fixed-dose combination with abacavir and lamivudine Not recommended for patients with recent exposure to cabotegravir as part of pre-exposure prophylaxis
Third drug – Protease inhibitors
Darunavir plus ritonavir	Preferred for initial treatment of patients with early (acute or recent) HIV infection and a history of cabotegravir exposure as part of pre-exposure prophylaxis Well tolerated Pharmacokinetic data available and increasing experience with use in pregnancy Requires twice-daily administration during pregnancy

Preferred regimens for ART of treatment-naïve pregnant women with HIV consist of one of the dual NRTI combinations listed above plus one of the third drugs (a protease inhibitor or integrase inhibitor) listed above.

NRTI: nucleoside reverse transcriptase inhibitor; HLA: human leukocyte antigen; ART: antiretroviral therapy.

* The fixed-dose combination tenofovir disoproxil fumarate-lamivudine is available in the United States and may be available in some other countries.

Adapted from: Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States, HIV.gov 2023. Available at: clinicalinfo.hiv.gov/en/guidelines/perinatal/recommendations-arv-drugs-pregnancy-what-to-start-regimens-naive (Accessed on February 15, 2023).

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Preferred antiretroviral agents for treatment-naïve pregnant individuals with HIV in resource-rich settings