Tenofovir disoproxil (TDF)

• HIV in pregnancy (with emtricitabine + 3rd agent)
• Hepatitis B in pregnancy (viral load >200,000 IU/mL from 28/40)

Nucleotide analogue → inhibits reverse transcriptase and HBV polymerase.

• TDF — monitor Cr, phosphate, BMD
• TAF (alafenamide) safer kidneys/bone but less pregnancy data

TDF

300 mg PO OD

• CautioneGFR <50 — adjust dose
• CautionOsteoporosis / low BMD

• Renal tubulopathy (Fanconi)
• ↓ BMD
• GI upset

• • Extensive safety data in pregnancy — first-line
• • Prevents perinatal HBV when given from 28/40 + neonatal vaccine + HBIG

• NSAIDs

  Caution

  ↑ nephrotoxicity

• Didanosine

  Avoid

  ↑ ddI levels

• 💡 Continue throughout pregnancy and postpartum
• 💡 Switch to TAF postpartum if renal/bone concerns