Therefore, boosted PIs are preferred. Questions relating to PTD and

pharmacokinetics in the third trimester are addressed separately. A fixed-dose combination of zidovudine, lamivudine and abacavir is an option in this setting. In an RCT in pregnant women with a CD4 cell count >200 cells/μL (with no VL restriction) zidovudine, lamivudine and abacavir (NRTI-only group) were compared with zidovudine plus lamivudine combined BKM120 chemical structure with ritonavir-boosted lopinavir (PI group). Therapy was initiated at 26–34 weeks’ gestation and continued postpartum for 6 months during breastfeeding. By delivery, 96% in the NRTI-only group and 93% in the PI group had achieved VLs <400 HIV RNA copies/mL plasma despite baseline VLs >100 000 in 15% and 13%, respectively, with significantly more women in the NRTI-only group achieving VL <50 at delivery (81%) than in the PI group (69%). Overall, the HIV MTCT rate was 1.1% by the end of the breastfeeding period with no significant difference in transmission rates between the arms, although the study was not powered to address transmission and more transmissions were reported in the NRTI-only arm [21]. PTD (see Recommendation

5.2.3) was less common in the NRTI-only arm (15%) compared with the PI arm (23%), although this did not reach statistical significance. A fixed-dose combination of zidovudine, lamivudine and abacavir is generally

well tolerated, with a low pill burden and easily discontinued. In non-pregnant RVX-208 Pirfenidone datasheet patients, higher rates of treatment failure have been reported with the combination of zidovudine, lamivudine and abacavir compared with other HAART combinations when the baseline VL is >100 000 HIV RNA copies/mL plasma (BHIVA guidelines for the treatment of HIV-1 positive adults with antiretroviral therapy 2012; www.bhiva.org/PublishedandApproved.aspx). Although these groups are not comparable, the Writing Group recommend restricting the use of zidovudine, lamivudine and abacavir for PMTCT to women with baseline VLs <100 000 HIV RNA copies/mL plasma. 5.3.4 Zidovudine monotherapy can be used in women planning a CS who have a baseline VL <10 000 HIV RNA copies/mL and CD4 cell count >350 cells/μL. Grading: 1A Data on the efficacy of zidovudine monotherapy for PMTCT are well known: a 67% reduction, in ACTG 076, in transmission to 8.3% (treatment initiated 14–28 weeks, non-breastfeeding, low CS rate, baseline CD4 cell count >200 cells/μL) [16], a 50% reduction in a Thai study to 9.4% (mean treatment only 25 days and oral zidovudine during labour) [85]; 0.8% transmission for women treated with zidovudine monotherapy and assigned to PLCS in the Mode of Delivery study [86].