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conflicting doctors

Mar 9, 2001

In the new perinatal recommedation guidelines at , it states "The three-part ZDV chemoprophylaxis regimen, initiated after the first trimester, should be recommended for all HIV-infected pregnant women to reduce the risk for perinatal transmission." What is meant by "three-part ZDV"? Is this saying the same as take AZT alone? One doctor says wait untill 32-34 weeks to start AZT only and then stop after delivery if CD4 still good. "Save the drugs for later when really needed" he says. Another doctor wants to start 3 combination HAART right away and says once started can not stop. Just found out HIV+ two weeks ago. CD4 is 438 at 10 weeks pregnant. VL comes back next two weeks. Can you please advise who is right?

Response from Dr. Holodniy

I believe the "three part" AZT refers to treating the mother during the 2nd and 3rd trimester, at the time of delivery, and AZT treatment for the newborn. Although AZT alone has reduced the risk of HIV transmission to the baby from around 30% without AZT to 5-10% with AZT, there is still risk. That is because it is unlikely that AZT will reduce the viral load (replication) down to zero by itself. There is also the risk of AZT resistance if used alone. Many doctors would advocate treating pregnant women like any other adult with HIV. That is reduce the viral load to undetectable levels with effective combination therapy and essentially eliminate the risk of transmission to the fetus. There is potentially some greater risk to the fetus by using more drugs, which is why they should be started after the first trimester. MH

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