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What are the chances?
Sep 11, 2003

I am now 31 weeks pregnant & am HIV+. I started taking meds stavudine, lamivudine & nevirapine when I was 16 weeks pregnant & at that time my CD4 count was 147. I don't know what it is now. I wanted to know what the chances are that my unborn baby may have been infected with the virus before I started the meds as I was having unprotected sex with my partner before I found out my status though now we only have protected sex? I am worried - is there still a chance that the baby is not yet infected? I am meant to have a c-section. What happens if the baby is born prematurely by natural birth? Please help.

Response from Dr. Luzuriaga

Most mother-to-child HIV transmission (MTCT) appears to occur at or after delivery rather than during pregnancy. In adition, while MTCT has been reported during the first or second trimester of pregnancy, most in utero transmission likely occurs closer to delivery. So, there's a small possibility but it's not highly likely that you might have transmitted HIV to your baby early in the pregnancy.

To better understand your risks of transmitting HIV to your baby, a repeat viral load and CD4 count on therapy would be helpful. The viral load is probably the best indicator of MTCT risk. The risk of MTCT from women on therapy with undetectable plasma virus is < 1%. C-section may help to reduce your risk of transmission but is not currently recommended for women whose plasma HIV RNA (viral load) is under 3000 copies per ml (and whose risks of transmitting HIV are thus low).

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