Should postexposure prophylaxis (PEP) be given to pregnant or breastfeeding medical workers who have been exposed to HIV?

Updated: Jul 27, 2020
  • Author: Ana Elizabeth Markelz, MD, FACP, FIDSA; Chief Editor: John Bartlett, MD  more...
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Answer

Answer

As with all medications, the risks and benefits of PEP should be discussed with the pregnant medical worker who has sustained an exposure. All pregnant women starting antiretroviral therapy (ART) should be entered into the Antiretroviral Pregnancy Registry, a database designed to collect information on the outcomes of antiretroviral-exposed pregnancies regardless of HIV status. Most antiretroviral drugs are category B or C. Based on limited data, the benefit of antiretroviral drugs in pregnancy, including during the first trimester, outweigh the risks and do not appear to increase the risk of birth defects.

Drugs to avoid during pregnancy are well covered in Antiretroviral Therapy for Pregnant HIV-Infected Patients. Contraindicated medications per the FDA include efavirenz (which is contraindicated in the first trimester), indinavir, and the combination of didanosine and stavudine. According to CDC and FDA guidance, dolutegravir should also be avoided in the first trimester because of concerns regarding an increased risk of neural tube defects. [11] However, it is important to point out that the Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission does not place restrictions on either dolutegravir or efavirenz during pregnancy. [12] Based on increasing clinical experience with ART, PEP is indicated at any time during pregnancy when a significant exposure has occurred. [17]

Women who may have been exposed to HIV should avoid breastfeeding for 3 months after the exposure. Both HIV and antiretroviral drugs may be found in breast milk.


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