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Starting triple combo while pregnant?
Mar 7, 2000

A month ago I decided to take an HIV test and I found out that I am positive. I am 24 weeks pregnant. The OB/GYN gave me AZT and then a referral. Two weeks, while on AZT, I did my blood tests (because I had not done any initially. My CD4 is 418 and my viral load using the PCR is < 400 (undetectable). I am in a dilemma - Start triple combination or not? The Dr suggested that I should go on Combivir and Nelfinavir. Right now I do not know what to do. I look at my viral load and I think that maybe I should wait till when the baby is born(I am worried about the effects on the baby).

The Dr says that she is not sure whether the low viral load was due to the AZT - Is this possible? I had only taken it for only 2 weeks. And what is the effect of herpes zoster on the viral load and CD4 if any? With an undetectable

viral load if I take the combination will the purpose be to boost my immune system? What are the chances of getting resistance to AZT within the next 4 months? Please give me some clues which may help me to come to a decision

whether to start the triple or not.

Response from Dr. Jackson

Since you have an undetectable viral load and a healthy CD4 count you have many options; one you might consider is the addition of 3TC, which would reduce the chance of low level [<400 copies/ml] viral replication and is well tolerated during pregnancy, I would also recommend monthly RNA levels and the use of nevirapine [a single 200 mg dose when active labor begins]. I would recommend your baby to receive AZT for 6 weeks and a single dose [2mg/kg] of nevirapine at 48-72 hours of age.

John L. Sullivan, M.D.


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