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HIV prophylaxis during pregnancy
Sep 12, 2005

I am a healthcare worker who was recently had a needlestick from an HIV positive patient. My exposure was a pin prick through a glove with a large bore needle, with very little bleeding when attempted to bleed it. I am also in the early stages of pregnancy. I have been put on Combivir and Kaletra for PEP. Will these drugs have any teratogenic effects on my baby? How effective is this combination in prevention of HIV? I was told that the source's viral load is undetectable. Resistance to any other medications is unkown at this time. However, the regimen that the source is on led my provider to believe that there was some resistance in the past. Thanks in advance.

Response from Dr. Pierone

Hello, I am very sorry to hear about your recent needlestick.

One reassuring point is that I am not aware of reports of pregnant healthcare workers treated post-exposure prophylaxis that have had adverse pregnancy outcomes. Moreover, a higher rate of birth defects (aside from Sustiva) has not complicated pregnancies among the much larger population of HIV-infected women treated throughout pregnancy.

We believe that HAART (which includes this combination) is highly effective in preventing transmission, but we don't have precise percentages. It would not be possible or ethical to do a placebo controlled trial to acquire this information. But there are observational data that support the rationale for this strategy.

The fact that the source patient had an undetectable viral load is important since the level of virus is directly related to the risk of transmissibility. I wish you the best of luck.



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