Recent CD4 count of the woman is 820, viral load is 1897. She is 35 years old and not on ART. What should be the best option for planning a pregnancy. Husband is on ART for the past 8 months. What will be the suitable drug combination for preventing vertical transmission.

Starting HIV meds prior to conception (using non-efavirenz regimen) would minimize changes to acquire additional HIV strains from husband (Rx chosen with husband's treatment history in mind) so that approach has that advantage and would also allow for finding well tolerated regimen and achieving undetectable levels prior to conception. An alternative approach would be to start meds after third trimester. I have been involved with both approaches. with the low viral load of woman ordinarily easy to achieve prompt control of HIV levels (to undetectable levels). KH