ART Options and Treatment Decisions for Women of Reproductive Potential

ART Options and Treatment Decisions for Women of Reproductive Potential

CME Information

Nursing and Pharmacy Credits

Grant Support for this Webinar

Navigating the Webinar

Poll 1

Poll 2

ART Options and Treatment Decisions for Women of Reproductive Potential

Financial Relationships With Commercial Entities

Learning Objectives

Pretest Question 1

Pretest Question 2

Outline of talk

Key background points

Key background points

Key background points

Key background points

Key background points

How did new data last year shift attention to this topic?

Botswana Tsepamo Study – Birth Surveillance Zash R Botswana Tsepamo Study – Birth Surveillance Zash R. IAS, Amsterdam July 2018 Late Breaker Zash R et al. N Engl J Med 2018;379:979-81

Neural Tube Defects with Periconception DTG Zash R Neural Tube Defects with Periconception DTG Zash R. IAS, Amsterdam July 2018 Late Breaker Zash R et al. N Engl J Med 2018;379:979-81

What do we know about ART in women of reproductive potential or pregnant?

ARVs in 2019

ARVs for pregnant women

Not recommended vs not enough data

Not recommended vs not enough data

Which drugs preferred, alternative in guidelines?

Preferred first-, second- and third-line ART regimens in adults and adolescents (including pregnant women and women childbearing potential)

Current guidelines on dolutegravir in pregnancy

Dolutegravir and pregnancy

Class effect of INSTIs?

Pharmacokinetics of different ARVs in pregnancy

Sex differences in PK even without pregnancy

Sex differences in PK even without pregnancy

Sex differences in PK even without pregnancy

Sex differences in PK even without pregnancy

Sex differences in PK even without pregnancy

Most recent drug showing this: elvitegravir and cobicistat (p1026)

Other ARVs with PK changes in pregnancy

Putting it all together- Practical considerations

What should you consider?

Which ARVs are listed as “can be continued” or “should be switched off”

Other considerations in pregnancy

Monitoring of HIV labs during pregnancy

Comment on PrEP, pre-conception, and sex differences in general

Comment on PrEP

Pre-conception period

Contraceptives and ART (simplified)

More data needed

Women of reproductive potential

Burden of justification

Burden of justification

FDA says study in pregnant women justified when..

“Development of accessible treatment options for the pregnant population is a significant public health issue”

Conclusions

Conclusions

Posttest Question 1

Posttest Question 2

Question-and-Answer

See the IAS–USA website for instructions on claiming CME, pharmacy, nursing, or pharmacotherapy credits, or a certificate of participation.

Sexual Health, HIV Prevention, and Primary Care in 2019

Thank You