Dear Dr's. I am 11 weeks pregnant and HIV+. CD4 is 438, VL not back yet from lab. I want to protect my baby from becoming infected. When should I start HAART and which drugs should I start to combine. Cost of the drugs is factor but dont want to do monotheripy with AZT alone for fear of building resistance. I'm in Thailand. Can you please help?

Currently the standard of care for HIV treatment during pregnancy in Thailand is AZT alone. In the United States, we recommend that women be on a combination of HIV medications that will make the viral load in the blood undetectable. AZT by itself has been shown to reduce the risk of transmission of HIV to the baby significantly. Combination therapy can reduce this risk even more. Also, as you mention, another problem with just taking AZT alone is that the virus may become resistant to AZT.

I am going to recommend that you see an expert in HIV in Thailand to discuss your options. You can contact Dr. Woraphot Tantisiriwat at Vajira Hospital on Samson Rd, Dusit, Bangkok. He will direct you to an expert who treats HIV during pregnancy.