Im hiv positive and pregnant my Viral load is 194 and my Cd4 is 1059 and im not at any medication yet, i just want to know when is the right time to start with the med as i dont want to start too soon or too late and also dont want to continue with the med after birth, is the med i can take just before i give birth that will work effective to reduce the risk passing the virus to the baby?

It sounds as if you are doing quite well and would not necessarily qualify for therapy if you are asymptomatic with CD4 of 1059 and RNA of 194. However, antiretroviral therapy (ART) is recommended for all pregnant women, when available, to prevent mother-to-child transmission of HIV. While the risk of transmission drops quite markedly when a mom's viral load is under 1000, transmission can occur at any viral load and ART is highly protective.

Treatment around the time of delivery can help to prevent transmission but antiretroviral therapy begun during pregnancy is far more effective; therefore, whenever possible, antiviral therapy is recommended during pregnancy to decrease maternal viral load as much as possible. Women with undetectable viral loads have < 1% chance of passing the virus to their babies.

The choice of therapies depends on a number of factors, including what is available for use. Almost all licensed antiretroviral drugs appear to be safe for use during pregnancy; only efavirenz is not recommended for use during pregnancy. Many experts advocate resistance testing for pregnant women to help guide the selection of ART. The US Guidelines for the Use of Antiretrovirals During Pregnancy are available on this web site under the "Treatment" section. This document has lots of good information on mother-to-child HIV transmission and the use of ART to prevent transmission. I would urge you to review this and discuss your options with your care provider.