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abacavir,3tc,viracept use throughout pregnancy
Dec 7, 2000

I know the textbook answer (treat the woman,class c, etc.,etc.), but I'm looking for other information (even behind the scenes talk) that may ease my mind about using these drugs during first trimester and beyond. Are a lot of Drs continuing meds like mine did in first trimester? I'm especially concerned with abacavir . I'm 18 weeks now and was advised to stay on drugs when I first found out I was pregnant. Also, I have a new Dr that doesn't get very excited about viral load if T-cells are stable,but I don't want to let it get out of control. I was 300, now I'm (just recently) 6500. At what point do I consider switching regimens during pregnancy? This Dr mentioned the possibility of continuing with some suppression as long as t-cells were stable until after pregnancy. He seems to have different theories than my past Drs, who were aggressive and would probably switch me asap, and I was wondering if other Drs are leaning this way in treatment? I've had diagnosed HIV since 1986 at age 15, so I've been around the block, have knowledge, and feel I can advocate effectively for whatever course I want to take, even if it differs from my Drs.(He seems pretty cool so far) Sorry this is so long. So much is going through my head and I want to do what's best for my baby. (ps-T'cell's are higher than ever at 710)

Response from Dr. Sullivan

You present a complex issue; you are right in being concerned about viral load, there is no question that risk of maternal to child transmission is lowest[close to zero] for both in utero and intrapartum[ labor and delivery] forms of transmission when the viral load is undetectable; I believe that this should be the goal of therapy, if this is not achievable then I would consider using single dose nevirapine[providing you haven't had prior experience with the nonnucleoside reverse transcriptase inhibitors] during labor and delivery. These decisions are best made with an HIV specialist with experience in treating pregnant HIV infected women. JLS.

John L. Sullivan, M.D.


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