| | 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
|
