| 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
- Small risk of neural tube defects when used at the time of conception; no excess risk with initiation during pregnancy
|
Raltegravir | - Rapid viral load reduction; preferred for women presenting late in pregnancy or with high viral load
- Useful when drug interactions with protease inhibitor regimens are a concern
- Pharmacokinetic data available and increasing experience with use in pregnancy
- Requires twice-daily administration
|
Third drug - Protease inhibitors |
Atazanavir plus ritonavir | - Once-daily administration
- Extensive experience in pregnancy
- Can cause maternal indirect hyperbilirubinemia
|
Darunavir plus ritonavir | - Well tolerated
- Pharmacokinetic data available and increasing experience with use in pregnancy
- Requires twice-daily administration during pregnancy
|