Hi Experts,

My girlfriend and I are planning to have a baby.

We are both Poz (she is 40 and I am 42yrs). I am not on medications (my vl is around 1400 and Cd4 around 560). She is currently on Sustiva and Truvada.

We realized that sustiva is not advisable during pregnancy, hence she would have to go off it. First, how long should she go off sustiva before becoming pregnant.

And if she should go off it, what other alternative combinations should she go for. Her specialist has asked her to think of Keletra and/or Lexiva as a replacement. Which would be the best option?

We are aware of the potential for birth defects for people who have been on sustiva...how high is this potential? What other issues should we be aware of?

Efavirenz (Sustiva) is not recommended for use during pregnancy because of birth defects observed in baby monkeys whose mothers received the drug during pregnancy. Similar birth defects have also been noted in some human babies whose mothers took Sustiva during the first trimester of pregnancy.

When women are contemplating pregnancy, we therefore recommend that they switch to other antiretroviral therapy for at least a couple of months before becoming pregnant. While Sustiva would be cleared from the system over a matter of several days, waiting a couple of months would allow evaluation of how your girlfriend is tolerating the new regimen and whether the new regimen is working well to suppress the virus.

The goals of treatment during pregnancy are to optimize the mother's health and to minimize the risk of transmitting the virus to the baby. The choice of new medications would really depend on your girlfriend's course thus far and what medications she has already been on. Kaletra and Lexiva are protease inhibitors. Because they are relatively newer than some other HIV medications and are often used after other regimens have not worked, there is less extensive experience with these antiretrovirals during pregnancy; however, Kaltra has probably been used more extensively than Lexiva and clinical trials studying the safety and pharmacokinetics (how best to dose) of Kaletra are currently underway in pregnant women. For more detailed information on experience with these and other antiretrovirals in pregnancy, I would recommend that you read the "Guidelines for the Use of Antiretroviral Agents During Pregnancy", available on this web site under the "Treatment Guidelines" section. This document reviews the rationale and recommendatioons for using antiretrovirals during pregnancy and what to consider in determining an optimal regimen. You should then discuss your options with your girlfriend's care provider to determine what would be best for her and the baby.