Challenges, risks, and opportunities of antiretroviral drugs in women of reproductive potential

ABSTRACT

Introduction

The HIV/AIDS epidemic has been one of the greatest challenges in global health, significantly affecting women of reproductive potential. Considerable advances in antiretroviral therapy for women living with HIV have contributed to improvements in quality of life, better reproductive and birth outcomes, and a reduced risk of perinatal transmission.

Areas covered

Despite the progress made, persistent challenges in access and adherence to antiretroviral drugs may limit their benefits for some women. More pharmacokinetic and safety studies in pregnant and lactating women are urgently needed, as are prospective surveillance systems to evaluate associations between fetal and infant antiretroviral exposures, drug–drug interactions, and pregnancy outcomes.

Expert opinion

Multipurpose technologies, such as combined HIV and other STI or unintended pregnancy prevention, and innovative delivery methods, such as the development of long-acting antiretrovirals, have the potential to reduce adherence challenges and enhance quality of life for women with HIV. Parallel advances in drug safety testing and surveillance are needed to ensure the health and safety of women with or at risk for HIV and children at risk for perinatal transmission.

KEYWORDS:

• Antiretroviral
• women
• HIV
• reproductive age
• pregnancy
• infant feeding
• breastfeeding

Article highlights

• Antiretroviral therapy (ART) has greatly improved the quality of life for people with HIV, including women of reproductive potential, by supporting reproductive autonomy and leading to better health outcomes.

• ART has substantially reduced the risk of perinatal transmission of HIV when taken with good adherence during pregnancy, labor, delivery, and breastfeeding. However, challenges and risks are associated with ART use among women of reproductive potential, including difficulties in access, maintaining good adherence, and lack of awareness of PrEP options.

• Prenatal exposures also have the potential to adversely affect the developing fetus, and our knowledge of the potential adverse effects of newer agents on the fetus is often inadequate.

• Most contraceptive methods are safe for use by women with HIV who desire to prevent pregnancy, but potential drug interactions between certain hormonal contraceptives and ARVs need further study.

• There is a current challenge in the lack of systematic surveillance of the effects of prenatal exposures, and comprehensive population-based systems are needed for thorough pharmacovigilance of newer ARV agents.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.