Next Pregnancy, drugs choices and options
Sep 23, 2007
Hi docs; it has been a while since I last posted a quetion here. I was pregnant of my first baby, vanted to go under amnio and had to decide which meds where more suitable. Now my boy is 4, born already HIV -, with a C section and I had the amnio in time giving me a lot of serenity for the second half of the pregnancy. I'm + since 10 years, not on meds, CD4 in the rage of 800/900 VL 200/2000 (average, I'm checking every 6 months). I just turned 36 and I would love to have another baby. When I founf out about being HIV+ from an accident in a developing country I did decide I would have lived my life plenty and a second child it's part of it. Yes, I do understand a second pregnancy could decrease my immune system and drive me to meds earlier than I would expect; on the other side I want to give to my son a brother or a sister and nobody is sure about how long there's still to live even being perfectly healthy. So, before I start "working" on this project I'd like to know what are the latest indications in relation to when to start meds (I'll go for another amnio), which could be the best possible mix and most of all if, after a couple of studies conducted on hiv + women, to start meds earlier because of the amnio is still a viable option or there's evidence that the transmission risk is not really increased by the practice.
Thanks a lot for your attention and time. Ah, forgot to mention; I live in Italy and have access to the best treatments in the country.
Response from Dr. Pierone
Here is a link to the U.S. guidelines for prevention on perinatal transmission of HIV infection. The recommendations include a suggestion that Combivir (AZT and 3TC) be used as the nucleoside backbone and this is based the long history of the use of these agents in pregnancy. Some of the newer agents don't have studies which demonstrate safety yet.
Because of the contamination of Viracept (nelfinavir) with ethyl methanesulfonate (EMS) this medication should not be used during pregnancy. This leaves Kaletra as the recommended protease inhibitor for pregnant women. I skipped over the potential use of Viramune (nevirapine) because your CD4+ lymphocyte count is greater than 250 cells and there would be a higher risk of liver toxicity at this level.
If you are planning an amniocentesis then it makes logical sense to start your regimen before this procedure in order to further reduce the (very low) risk of transmission.
Best of luck with your project!
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