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Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States

Entry Inhibitors

Enfuvirtide (Fuzeon, T-20)

(Last updated:7/31/2012; last reviewed:7/31/2012)

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Enfuvirtide (Fuzeon, T-20)  is classified as Food and Drug Administration (FDA) Pregnancy Category B.
 
Animal carcinogenicity studies
Enfuvirtide was neither mutagenic nor clastogenic in a series of in vitro and animal in vivo screening tests. Long-term animal carcinogenicity studies of enfuvirtide have not been conducted.

Reproduction/fertility animal studies
Reproductive toxicity has been evaluated in rats and rabbits. Enfuvirtide produced no adverse effects on fertility of male or female rats at doses up to 30 mg/kg/day administered SQ (1.6 times the maximum recommended adult human daily dose on an m2 body surface area basis).

Teratogenicity/developmental toxicity animal studies
Studies in rats and rabbits revealed no evidence of harm to the fetus from enfuvirtide administered in doses up to 27 times and 3.2 times, respectively, the adult human daily dose on an m2  basis.

Placental and breast milk passage
Studies of radiolabeled enfuvirtide administered to lactating rats indicated radioactivity in the milk; however, it is not known if this reflected radiolabeled enfuvirtide or metabolites (such as amino acid and peptide fragments) of enfuvirtide. It is not known if enfuvirtide crosses the human placenta or is excreted in human milk. A published case report of two peripartum pregnant patients and their neonates and data from an ex vivo human placental cotyledon perfusion model suggest that enfuvirtide does not cross the placenta.1,2

Human studies in pregnancy
Very limited data exist on the use of enfuvirtide in pregnant women.1,3-5 There is a single case report detecting no placental transfer of drug based on cord blood measurements.5

References

  1. Brennan-Benson P, Pakianathan M, Rice P, et al. Enfurvitide prevents vertical transmission of multidrug-resistant HIV-1 in pregnancy but does not cross the placenta. AIDS. Jan 9 2006;20(2):297-299. Available at http://www.ncbi.nlm.nih.gov/pubmed/16511429.
  2. Ceccaldi PF, Ferreira C, Gavard L, Gil S, Peytavin G, Mandelbrot L. Placental transfer of enfuvirtide in the ex vivo human placenta perfusion model. Am J Obstet Gynecol. Apr 2008;198(4):433 e431-432. Available at http://www.ncbi.nlm.nih.gov/pubmed/18241815.
  3. Cohan D, Feakins C, Wara D, et al. Perinatal transmission of multidrug-resistant HIV-1 despite viral suppression on an enfuvirtide-based treatment regimen. AIDS. Jun 10 2005;19(9):989-990. Available at http://www.ncbi.nlm.nih.gov/pubmed/15905684.
  4. Meyohas MC, Lacombe K, Carbonne B, Morand-Joubert L, Girard PM. Enfuvirtide prescription at the end of pregnancy to a multi-treated HIV-infected woman with virological breakthrough. AIDS. Sep 24 2004;18(14):1966-1968. Available at http://www.ncbi.nlm.nih.gov/pubmed/15353987.
  5. Weizsaecker K, Kurowski M, Hoffmeister B, Schurmann D, Feiterna-Sperling C. Pharmacokinetic profile in late pregnancy and cord blood concentration of tipranavir and enfuvirtide. Int J STD AIDS. May 2011;22(5):294-295. Available at http://www.ncbi.nlm.nih.gov/pubmed/21571982