Use of efavirenz during pregnancy: A public health perspective
Technical update on treatment optimization
Efavirenz (EFV) has been recommended as the preferred option for a non-nucleoside reverse transcriptase inhibitor in optimized first-line antiretroviral regimens. However, concerns persist about its safety in early pregnancy, resulting in more complex treatment algorithms for HIV-infected women who might become pregnant and for women in early pregnancy, and ongoing confusion regarding when to use EFV and when to use nevirapine.
This technical update reviews the evidence on the safety, tolerability and efficacy of EFV, as well as the clinical and programmatic consequences of multiple algorithms due to uncertainty regarding the risk of teratogenicity from the use of EFV in pregnancy. Review of the available data and programmatic experience provides reassurance that exposure to EFV in early pregnancy has not resulted in increased birth defects or other significant toxicities.