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On December 14, 2007, the CDC provided updated guidance about the choice of antiretrovirals to use in occupational postexposure prophylaxis (PEP) for HIV. Specific changes relate to the use of the PIs nelfinavir and lopinavir/ritonavir.
Nelfinavir should no longer be used in pregnant women, because of concerns that the drug contains ethyl methanesulfonate (EMS), a known animal carcinogen, mutagen, and teratogen (ACC Sep 24 2007). Whether EMS has similar effects in humans, and whether it can cross the placenta or be secreted into human breast milk, remains unknown. Reassuringly, data from the Antiretroviral Pregnancy Registry from 1998 to 2007 show no difference in the rate of birth defects between pregnant women who received nelfinavir and t…