Safer Drugs for Prevention of mother to child transmission

Nov 10, 2010

My Girlfriend and I are Hiv positive with her CD4 at 480 and 720 for me. We do not at the moment take any ARVS but she is 17 weeks pregnant. She was told at the PMCTC clinic that she will start treatment at 28 weeks with COMBIVIR AND NEVIRAPINE. I am a Pharmacist and What I know is that although these two Drugs are more Toxic than The newer drugs such as Truvada and Kaletra, they are preferred choice for Prevention of mother to child transmission because their effectiveness and usage in this respect is very well Known. The newer protease inhibitors and Integrase inhibitors are not available in this part of Africa. Can I suggest to my prescriber to put her on Truvada and kaletra/Nevirapine at 28 weeks or she should start with their recommendation of Combivir and nevirapine and she can then switch to Truvada and Kaletra after delivery or do you have any other suggestion?

Thanks doc,

Mebs

Response from Dr. Henry

Combivir + Nevirapine has had lots of use in pregnancy but there are safety concerns if the CD4 count > 250 for women. In our clinic we often have used Kaletra (or other boosted protease inhibitor) + Truvada which can be a challenge to tolerate from the stomach standpoint but is effective for HIV control and avoiding resistance. KH