Dear Dr. Young I am an Medical Assistant in Rhode island and my best friend is pregnant and HIV+. She is asking me a lot of stuff about HIV but my knowledge is limited. She is pregnant for 5-6 weeks now her LMP was july 13, 2005. She was taking sustiva & combivir before until Aug. 15, 2005 she stopped taking it as per doctors advice until the 3rd trimester.Then she has to take a HAARt suitable for pregnancy. She is so worried that there will be an effect to the fetus. Did you know somebody who took sustiva during the 1st month of pregnancy that the baby turned out fine and free of defects? What are the chances of her having a normal and healthy baby of the mother who took sutiva for 1st month of pregnancy? By the way her CD4 is 800 and VL is <50. Doctor i am hoping for your reply so I have something to tell my friend the next time she ask me. Thank you and more power to all of you.

BHP

Dear BHP-

Thanks for your post and concern about your friend.

Overall, the risk is low for any efavirenz-related fetal toxicity given the relatively short (albeit important) period of exposure; hence the baby should be ok. The difficult thing is to try to estimate the risk in a numerical way.

Nonetheless, it's fair to also say that medical prudence would indicate close monitoring (ultrasound, etc) for any problems.

Since you're in RI, there is much expertise about HIV and pregnancy. I'd make sure that your friend has access to such a specialist, if possible.

Good health, BY