Antiretroviral therapy

The use of antiretroviral drugs in pregnancy should be considered for two indications: the health of the mother and prevention of transmission^364,290,291. Pregnancy should not be a contra-indication for antiretroviral therapy in the mother, if indicated. The use of ZDV in the prevention of transmission to the fetus has been discussed above^375,376,377. Current recommendations for adult antiretroviral therapy are that monotherapy with ZDV is sub-optimal treatment and that two antiretrovirals with the possible addition of a protease inhibitor is preferable^{288,289,378,379}. Although there is a theoretical risk to the fetus from combination therapy, there is limited experience with the use of other antiretrovirals such as lamivudine, stavudine, and protease inhibitors in pregnancy. Some have recommended stopping these therapies during the first trimester and restarting the combinations, but this also carries a risk of developing resistance. Detailed recommendations have been released in the USA on combination therapy in pregnancy²⁹¹. As many of the newer compounds do not have long-term safety data following use in pregnancy, this should be discussed with the patients. The use of any antiretroviral drugs should be accompanied by an explanation of the available knowledge to the women and advice that there should be long-term follow-up of the child²⁷².