Our history. I am positive vl less than 50. She is positive vl 10k, Tcell 650. Her doctor did not recomend medication in the past. Now she is pregnant. What are the chances of the baby being infected if she continues the pregnancy?

Under the current guidelines for treatment of adults, treatment may not have been recommended for your partner if she has not had symptoms and her VL/CD4 are as you describe. However, now that she is pregnant, she should be re-evaluated and therapy should be re-considered. Most experts would recommend antiretroviral therapy to optimize maternal health and to prevent transmission of the virus to the baby. Recommended regimens vary depending on the woman's prior antiretroviral experience, CD4 count, and viral load. The risk of transmitting the virus is 1% or less when a woman is on therapy and her blood HIV level is under 1000 copies/ml, so most practitioners aim to reduce blood viral load to less than 1000 when prescribing a regimen.

The Guidelines for the use of antiretroviral agents during pregnancy have just been revised and are available on this web site or at www.hivatis.org. They contain a nice discussion of what we know about mother-to-child transmission of HIV, the various measures that can be taken to prevent mother-to-child transmission, and a discussion of the safety and efficacy of various antivirals during pregnancy. I would urge you and your partner to to review these guidelines and discuss treatment with your care provider.