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Change in Meds
Aug 17, 2006

I am 7 months pregnant and have had HIV for 4 years without treatment. After finding out I was pregnant, I began therapy and seeing an OB doctor. I have recently began taking combivir and septra for my infection. I began with a viral load of 6544 and t-cell count of 161. After one month of treatment the viral load was 94 ant the t-cell count was 150. After going back to the doctor he place me on viracept and combivir. Why would I need to take both If I was doing fine with the one medication?

Response from Dr. Young

Thanks for your post.

I definitely agree that it's time for HIV treatment. With your CD4 count less than 200, you have a laboratory definition of AIDS. As such, irrespective of pregnancy, treatment is recommended. Trimethoprim/sulfamethoxaxole (Septra, Bactrim, Cotrimoxazole) is also recommended to prevent pneumocystis pneumonia (PCP).

If you live in a country where three drug therapy for HIV is standard (US, Europe, for example), then It's highly preferrable for your (and your baby) to be receiving a HAART regimen. Combivir + nelfinavir (Viracept) is a popular regimen during preganany-- it's use, compared with Combivir alone, should decrease the risk of developing drug resistance (to AZT and3TC) and further decrease the risk of transmission of HIV.

The part of your story that worries me is that you received dual nucleoside therapy alone for 1 month-- a situation that is suboptimal (if the other drugs are available). Because of this, I'd tend to want to see you receive the more potent boosted PI option, lopinavir/ritonavir (Kaletra).

I hope this helps. Keep us informed of your progress and health.

Best of luck to you and child. BY



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