Safety of Efavirenz in First-trimester of Pregnancy

OBJECTIVE To evaluate the safety of using efavirenz(EFV)-containing antiretroviral therapy(ART) regimens in the first trimester. METHODS This review was based on the representative meta-analysis data. It introduced the changes of guidelines in the context of EFV-exposed pregnant women, compared the recommendation level of EFV in the different guidance for pregnancy, expounded the pharmacokinetics of EFV and introduced the dosage during pregnancy. RESULTS The first introduced generation of non nucleoside reverse transcriptase inhibitor, EFV had significant effect on HIV-1 virus, but a few animal experiments and human clinical data at early stage showed fetal neural tube defects with EFV based regiments, which led to a restriction of EFV use in the first trimester. With the increasing of women exposed to EFV during the first trimester, some meta-analysis and the Antiretroviral Pregnancy Register data reported first-trimester exposure had no increased risk of overall congenital anomalies. The risk of neural tube defects associated with EFV remained low and was comparable to the general population. But human data remained so limited that just some guidance recommend EFV during the first trimester. CONCLUSION It's necessary to evaluate the individual condition for appropriate pregnant ART treatment.