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Updated guidelines for perinatal antiretroviral Use, U.S. Department of Health and Human Services, September 14, 2011

Antiretroviral therapy for HIV-infected women who do not require treatment for their health may be deferred until the second trimester, but earlier initiation of may be more effective in reducing in utero transmission.

Intravenous azidothymidine (AZT) should be given during labor to HIV-infected women who did not receive antiretrovirals during pregnancy, and combination antiretroviral prophylaxis should be administered to the infant for 6 weeks. Single-dose nevirapine during labor is no longer recommended.

Tenofovir is considered an "alternative" nucleoside reverse transcriptase inhibitor (NRTI) choice during pregnancy.

Lopinavir/ritonavir (twice daily) remains the "preferred" protease inhibitor during pregnancy. Increased dose is required during the second and third trimesters — 600 mg of lopinavir and 150 mg of ritonavir, each twice daily

Lopinavir/r should not be administered to neonates before a postnatal age of 14 days.

Combination antiretroviral therapy is recommended for pregnant women with HIV/hepatitis B virus co-infection. The NRTI backbone in these regimens should consist of two drugs that are active against HBV; the preferred pairing is tenofovir with either FTC or 3TC.


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