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Raltegravir in Pregnancy — SCE Infectious Diseases MCQ

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ModerateHIV MedicineRaltegravir in PregnancySCE Infectious Diseases

A 30-year-old woman with well-controlled HIV on ART becomes pregnant. She is on Raltegravir/Tenofovir DF/Emtricitabine. Her team considers switching to a preferred pregnancy regimen. According to BHIVA 2025, can Raltegravir be continued?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Raltegravir can be continued in pregnancy if the patient is virally suppressed and tolerating it well — but Dolutegravir is now the preferred INSTI in pregnancy due to superior PK and once-daily dosing

BHIVA 2025 pregnancy guidelines recommend Dolutegravir as the preferred INSTI in pregnancy (supported by extensive safety data from the Tsepamo study and others). However, Raltegravir can be CONTINUED if the patient is already virally suppressed and tolerating it well — there is no safety concern requiring mandatory switching. Raltegravir's disadvantages in pregnancy include: twice-daily dosing, lower genetic barrier to resistance, and altered PK in late pregnancy potentially requiring TDM. If switching, DTG is preferred. ART should never be stopped in pregnancy.

Reference: BHIVA 2025 – HIV in pregnancy; WHO 2022 – ART in pregnancy