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Truvada/Stocrin or Nevirapine/Combivir???????
Feb 7, 2007

Hi. Greetings from Kenya.

I tested positive in 2000. In 2002 I got pregnant CD4 327- VL100,000. I was not on any medication then. After the first trimester I was put on Combivir & Nevirapine until after I gave birth. At the time of birth (C/S) I was undetectable with CD4 of 600. Three months after birth I stopped the ARVs (not because of any side effects but for fear of toxity).

Last year June was always having blurred vision and feeling generally tired. Did a CD4 which was 188. Decided to go on medication. I am currently on Truvada/Stocrin for six months now with no side effects but still not taken my numbers. I have gained back my weight and generally feel good. Somehow the blurred vision and dizziness disappeared.

Now my most pressing concern is if I want to get pregnant again (which I do) will I have to change my ARVs. Ive read that there is no info on the safety of the regimen I am currently taking for pregnant women. If I go back to the Nevirapine/Combivir combo, just during pregnancy, will it be possible to go back to my current regimen Truvada/Stocrin which is easier to take and working well for me or will I have to stick to the Combivir/Nevirapine after birth? Will switching my regimens in this way make my virus resistant? Please let me know what my best options are for having a safe pregnancy without messing up with my regimens.

STL

Response from Dr. Wohl

Dear STL,

Your post raises several important issues.

First, the safety of your current regimen of Stocrin (Sustiva) + Truvada during pregnancy. Stocrin is not considered safe for pregnant women. Pregnant monkeys exposed to this drug have delivered offspring with severe deformities. There have been cases of women treated with this drug becoming pregnant and delivering healthy babies but I would highly recommend you not take this medication while pregnant. There are not a lot of data on Truvada and pregnancy but there is no reason to think it is unsafe.

The most data we do have on HIV medications and pregnancy is with Combivir as well as Nevirapine.

Your options are to switch to Truvada and Nevirapine or completely change to Combivir and Nevirapine prior to becoming pregnant. In either case, I think you can simply go back to Truvada + Stocrin later on. Do you plan on breastfeeding? If so, staying on Nevirapine may make sense. This is all assuming your current therapy is working, as it seems to be. A viral load on your current therapy would be nice.

Second, and this is hinted at above, if the virus is sensitive to the HIV medications, switching from one effective regimen to another should be fine as long as the new regimen is well tolerated. Stocrin and Nevirapine work in similar ways, so swapping these meds in your case should not be a big deal. If you do switch from Stocrin to Nevirapine many people think you do not have to take the Nevirapine once a day for 2 weeks and then go to twice a day. Rather, you can just start on Nevirpaine 200 mg twice a day if you are changing from Stocrin.

Lastly, as you probably know, having unprotected sex can lead to transmission of HIV to your partner if he is not HIV infected.

I hope this helps.

DW



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