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HAART during pregnancy
Apr 8, 2004

Dear Dr's. I am 11 weeks pregnant and HIV+. CD4 is 438, VL not back yet from lab. I want to protect my baby from becoming infected. When should I start HAART and which drugs should I start to combine. Cost of the drugs is factor but dont want to do monotheripy with AZT alone for fear of building resistance. I'm in Thailand. Can you please help?

Response from Dr. Lee

Your questions are very good ones. Although, they are difficult to answer with specifics because we don't yet know your viral level. Actually, if your viral load is relatively low, AZT monotherapy may be effective to prevent transmission. If you are to remain on AZT only during the pregnancy, it is less likely that resistance will develop. (Nucleoside resistance [except to Epivir] usually takes longer to develop.) However, especially if your viral load is great, you may need combination treatment not only for prevention of transmission to your baby, but for your own longer-term treatment.

Whether you can consider a combination with a protease inhibitor such as nelfinavir, a non-nucleoside such as niverapine (carefully), or just a second nucleoside such as lamivudine is really in part determined based upon the amount of virus active in your system.

As far as when to begin treatment, I would suggest fairly soon. Many doctors start mothers on therapy before 12 weeks, but after 12 weeks of pregnancy is generally agreed to be safe.

Be well.

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