User:Rdwing08/HIV and pregnancy

Copied from: HIV and pregnancy, intend to move from Lead to recommendations section

HIV can be spread through breastmilk. Mothers with HIV in resource-rich countries, such as the United States and European nations, are encouraged to avoid breastfeeding as the infant's diet can be appropriately supplemented. However, in resource-limited settings, the risk of HIV acquisition must be considered versus the risk of illness and death due to malnutrition and serious infection. is a greater risk of infant illness and death associated with avoiding breastfeeding exclusive breastfeeding is higher than the risk of contracting HIV, exclusive breastfeeding in a mother who is virally suppressed is encouraged. Copied from: Antiretroviral Drugs


 * Efavirenz is classified as a category D drug by the US Food and Drug Administration (FDA), which indicates that there are risks associated with its use during pregnancy. There is an uncertain potential for risk of developing birth defects In a study analyzing the use of the drug in pregnant women, 2.3% of births were associated with birth defects. However, a systematic review of the safety of EFV use in humans during the first trimester found no increase in birth defects among women using the drug. Given the uncertain potential for risk, the U.S. DHHS recommends against using EFV in the first trimester of pregnancy or in women who may become pregnant. They instead recommend a protease inhibitor based regimen with lopinavir (LPV) or ATV. However, to simplify regimens and provide a uniform recommendation for HIV-infected individuals during pregnancy, the WHO continues to recommend efavirenz as a first line agent for HIV positive women. Women using EFV prior to their pregnancy may continue with the drug as it is more dangerous to stop or change medications during pregnancy because this can result in improper control of the viral load.
 * Nevirapine (trade name Viramune, and shortened NVP) increases the risk of very serious liver damage in women with CD4 counts greater than 250 cells/mm3 . It is generally avoided in pregnant women. Women taking NVP safely prior to pregnancy may continue with the medication because NVP-related liver damage has not been seen in women previously using the medication.