Dear Doctor, 37-year old female, HIV+ since 1990. In 1997, I was put on meds (AZT and Epivir) because VL had risen to 80,000, though all my numbers were OK. In 2003, I was put off meds because of my general good conditions (CD4 1,200, % 52, VL undetectable for the first 2 years, later between 100 and 3,400). Three years have gone by without treatment. I am quite fine, apart from chronic fatigue. My numbers are total CD4 650, 39 %, viral load 12,000. My HIV - partner who has a problem of poor fertility insists on artificial insemination to have a baby. I know that in case of pregnancy, I should start therapy again but this does not worry me. What worries me is my long HIV-history; do you think this is compatible with a pregnancy and with a reasonable life expectancy so to see my baby grow? Thanks a lot

Your history of being HIV positive should not preclude as successful pregnancy and a reasonable life expectancy. However, to optimize your chances for a healthy baby, you are correct to consider some pre-pregnancy planning. While your current viral load and CD4 T cell count would not necessarily qualify you for therapy under current treatment guidelines, most experts would recommend that you begin therapy aimed at driving your viral load to undetectable. Beginning therapy before you get pregnant will allow you and your care provider to be sure that you are tolerating your medicines and that the medications are controlling the virus. The risk of transmitting the virus is under 1% in women with undetectable viral loads on therapy. For more information on preventing mother-to-child HIV transmission, please see the Guidelines for the Use of Antiretroviral Agents During Pregnancy (available on this web site, under the Treatment Guidelines section).