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Combination antiretroviral therapy during pregnancy.

© Lippincott Williams & Wilkins There have been important advances in our understanding of the pathogenesis and the treatment of HIV infection and AIDS. However, despite increased knowledge, the epidemic continues to have a significant impact on women, with increasing numbers of young women of childbearing age identified with HIV infection worldwide. In the United States it has been estimated that 7000 women with HIV infection become pregnant each year [1]. Pregnant women have traditionally not had early access to new or investigational drugs. However, in the era of AIDS and in the face of a potentially fatal illness, this is changing. Phase I trials of antiretroviral drugs are being carried out in pregnant women soon after phase I trials in nonpregnant adults and often with limited data available concerning the potential of a given drug for carcinogenicity, mutagenicity, teratogenicity and adverse reproductive effects. Antiretroviral agents are being prescribed for pregnant women for their own health prior to completion of clinical trials in this population. Information about proper dosing of these drugs during pregnancy and about their side-effects are derived from several sources, including preclinical studies in pregnant animals, clinical trials in pregnant humans, individual reported experiences, and pregnancy registries.