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Pregnancy with undectable viral load without medication
May 27, 2001

I am presently 36 weeks pregnant and HIV positive. I have never been on medication because my viral load was <50 and cd4 count 790. My physician insisted that I took medication during the last trimester of pregnancy but I did not think I actually needed it. I took combivir for two days, taking one in the morning and at night then stopped it, a week later I started the medication again, took it for four days and then finally stopped. All this happenned in the last month of pregnancy. I really do not want to start medication right now because it might mess up my immune system and also I do not want to transmit this disease to my baby. Please advice me on what to do? Do I have to have a ceasarien section to have the baby. The baby is due middle of next month or anytime from now.

Thanks for your response.

Response from Dr. Sullivan

Assuming your viral load remains less than 50 copies your risk of transmission to your infant is less than 1% but not zero; there are no studies of therapies in women such as yourself so depending on who you ask you are likely to get different opinions; you may want to give serious consideration to taking combivir and nevirapine through delivery and then stop therapy until treatment is indicated based on viral load and CD4 count; JLS.

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