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X. PEP FOR EXPOSED WORKERS WHO ARE PREGNANT OR BREASTFEEDING
A. Exposed Workers Who Are Pregnant
RECOMMENDATIONS:
Based on increasing clinical experience with ART, PEP is indicated at any time during
pregnancy when a significant exposure has occurred, despite possible risk to the woman
and the fetus. (AII) Expert consultation should be sought. When occupational exposure to
HIV occurs, every effort should be made to initiate PEP within 2 hours. (AII) The
recommended PEP regimen is the same for pregnant women as for non-pregnant adults
(see Section VIII: Recommended PEP Regimen). (AII)
Before administering PEP to a pregnant woman, the clinician should discuss the potential
benefits and risks to her and to the fetus.

The agents listed in Table 7 are all non-preferred agents for use in PEP regimens and are not
likely to be used; however, clinicians should be aware that these agents should not be prescribed
in exposed workers who are pregnant. Initiation of PEP at any time during pregnancy requires a
careful discussion of the risks and benefits.
PEP Drugs to Avoid During Pregnancy
Drug(s) to Avoid
Toxicity
Unboosted indinavir in the 2nd or 3rd trimester Substantially lower antepartum indinavir plasma concentrations; risk for nephrolithiasis Key Point:
In addition to the risk of seroconversion for the exposed worker, the high viral load levels
associated with the acute retroviral syndrome markedly increase the risk of transmission to the
fetus or breastfeeding infant.34

Although birth defects and adverse effects on human fetuses have generally not been associated
with the antiretroviral agents that are currently available, exposure of a fetus to antiretroviral
agents during pregnancy carries a theoretical risk of teratogenicity.
For additional information, refer to NYSDOH guidelines on Use of ART in HIV-Infected
Pregnant Women.


B. Exposed Workers Who Are Breastfeeding
RECOMMENDATION:
Clinicians should advise women who may have been exposed to HIV through occupational
exposure to avoid breastfeeding for 3 months after the exposure. (AII) If HIV infection is
definitively excluded in the source patient at any time prior to 3 months postexposure, the
woman may resume breastfeeding.

Initiation of PEP in exposed workers who are breastfeeding requires careful discussion. Both
HIV and antiretroviral drugs may be found in breast milk; therefore, breastfeeding should be
avoided for 3 months after the exposure to prevent HIV transmission and potential drug
toxicities.34 Clinicians should discuss the risks and benefits with the exposed worker. The
infant’s pediatrician should be informed of any potential exposure to HIV or antiretroviral
medications.

Source: http://cei2.urmc.rochester.edu/documents/pep/PEP%20for%20Exposed%20Workers%20who%20are%20Pregnant%20or%20Breastfeeding.pdf