Use of efavirenz during pregnancy: A public health perspective Technical update on treatment optimization; 2012

This technical update reviews the evidence on the safety, tolerability and efficacy of EFV, as well as the clinical and programmatic consequences of multiple algorithms due to uncertainty regarding the risk of teratogenicity from the use of EFV in pregnancy. Review of the available data and programmatic experience provides reassurance that exposure to EFV in early pregnancy has not resulted in increased birth defects or other significant toxicities. In addition, new evidence suggests that EFV is clinically superior to NVP, as it provides better long-term viral suppression, has fewer adverse events and less risk of resistance. Finally, the cost of EFV has decreased considerably, and it is now increasingly available as part of once-daily fixed-dose combinations. Based on the available data, programme experience and a public health perspective, this interim guidance provides further support for the use of EFV as part of the World Health Organization (WHO) strategy to optimize and simplify first-line treatment, including among pregnant women and those of reproductive age. Further review of the safety of EFV and its use in pregnant women and those of reproductive age will be included as part of a comprehensive revision of the WHO ART guidelines, planned for 2013.