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On September 14, 2011, the U.S. Department of Health and Human Services released an updated version of its guidelines for perinatal antiretroviral use. The most important changes in clinical recommendations are as follows:
Tenofovir is now considered an “alternative” nucleoside reverse transcriptase inhibitor (NRTI) choice during pregnancy, instead of being limited to “use in special circumstances.” This shift likely reflects current practice patterns, as well as Antiretroviral Pregnancy Registry data showing no excess risk for birth defects among 1092 infants exposed to tenofovir during the first trimester. However, concerns about the drug remain because of animal studies showing decreased fetal growth and reductions in fetal bone porosity.…