Rilpivirine during pregnancy



Sixteen pregnant women on rilpivirine therapy were included in a pharmacokinetic study of rilpivirine exposure during third trimester and postpartum. Intensive sampling was performed during 24 hours in late pregnancy and postpartum. Area under the curve (AUC), maximum observed concentrations and minimum observed concentrations were measured and calculated. Geometric mean ratios of third trimester versus postpartum concentrations showed significant differences. The ratio was 0.55 for AUC, 0.65 for maximum concentration and 0.51 for the minimum observed concentration. The cord to maternal concentration ratio was 0.5. No detectable viral loads were observed and no mother to child transmission occurred. The authors conclude that rilpivirine may be an alternative treatment option for pregnant women who are virologically suppressed if they are closely followed with viral load measurement and or therapeutic drug monitoring.

Schalkwijk et al. Clin Infect Dis 2017;65: 1335-1341

Comment: The rilpivirine concentration is substantially lower in late pregnancy and may be lower than the target concentration. Safer options are readily available. Taking the low exposure and the limited experience with rilpivirine in pregnancy into consideration other alternatives seem preferable.