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Protease Inhibitors and Pregnancy

Feb 21, 1997

I am interested in any advise or information on taking PI`s while Pregnant? My counts have dropped from 500 to 300 within the last month and my doctor says it is up to me because there is no information available as to the effect on the newborn!

Response from Dr. Cohen

Your doctor is right -- there is no information. To date, the only drug that has been formally studied in pregnant women has been AZT. As you probably know, results in that study were dramatic: AZT markedly reduced transmission from mother to infant.

However, most people feel that there's nothing magic about AZT and that the important thing is to lower the viral load of the mother. While AZT might do that in some women, a woman who's been on AZT in the past and has resistant virus might not respond in the same way, and there may be less benefit to the infant.

There's a growing trend toward treating HIV-infected pregnant women the way you would treat anyone else, by giving them the best therapy available to lower their viral loads. That approach has come about in part because many women become pregnant while already taking combination therapy, and by then any damage to the fetus would have already taken place. It's somewhat harder when you're faced with the decision of knowingly starting new drugs while pregnant--always a scary proposition.

Your doctor is right -- the decision is up to you. Taking a combination regimen that will lower your own viral load will be the best thing for your own health, and will minimize the chances that your baby will be infected. On the other hand, you have to balance those benefits with the small possibility that the drugs might have harmful effects on the fetus.

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