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Undetectable Viral Load Without Meds
Apr 10, 2000

I am an HIV/AIDS counsellor In South Africa. I have an HIV+ client who has had undetectable viral load without medication (even at 50 copies) since she tested positive. Her CD4 count started at 1540 and is currently at 1790. She would like to get pregnant. Now what are the chances of

1. transmission to the baby without her taking medication?

2. transmission with her taking medication in view of her undetectable viral load and high CD4 count?

Are there other cases similar to this one?

Response from Dr. Luzuriaga

Risk of transmission in the absence of antiviral therapy generally increases as maternal viral load increases or CD4 count decreases. Other factors (such as length of time since acquisition of infection and HIV-specific immunity) may also be important. While the risk of transmission with viral load < 50 (on or off meds) is low, it is not nil.

In PACTG 076, antiviral therapy reduced the risk of transmission across all CD4 and viral load levels. Many think that this is because therapy of moms and infants provided antiviral drug levels in the infants that provided prophylaxis against infection. Antiviral therapy of women and their infants, if available, is still therefore generally recommended to provide additional protection against transmission.

Most of the data that I am basing my recommendations on come from studies done in the U.S. and Europe. Several perinatal antiviral studies have been recently completed or are currently being conducted in South Africa, so hopefully we will soon have data more specific to your locale.

Katherine Luzuriaga, M.D.

long term survivors,38 years old, wants a baby
HIV+ woman having unprotected sex with HIV+ man.

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