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advice please
Apr 29, 2004

Hello doc, I myself and my wife both are hiv positive. Myself, I am taking combination of stavudine 40mg+ lamivudine 150mg+ nevirapine 200mg twice a day My wife hasn't started any medicine because her cd4 count is 450 and her viral load is 10000. My wife is pregnant now and our doc say she have to wait 3 months period for starting of medicine. Our doc say that antiretrovirals can't be given in the first 3or 4 months. Kindly tell me what should I do. My wife should start which treatment? Is there any medicine which affects on both way. I mean to say for my wife's treatment and for protecting baby from hiv.

Please let me know. Thanks

Response from Dr. Luzuriaga

Antiviral therapy is one of the most important measures that your wife can take to prevent transmission of the virus to the baby. Since most of the baby's organs form during the first 3 months of pregnancy, some care givers feel more comfortable waiting until the first trimester (three months) is over before they prescribe antiretroviral treatment. However, many HIV positive women have continued on or started antiretrovirals during the first trimester without apparent ill effect to their infants, and many experts feel comfortable starting therapy during the first trimester. The only antiretroviral that is not generally recommended during pregnancy is efavirenz, since efavirenz dosing of pregnant monkeys was associated with birth defects in their infants. Because of the potential risk of liver toxicity, some practitioners are cautious about using nevirapine in pregnant women. The Guidelines for the Use of Antiretroviral Agents to Prevent Mother-to-Child Transmission is a comprehensive document that reviews the rationale for starting therapy during pregnancy, outlines therapy options, and discusses antiretrovirals; it is available on this web site in the Treatment Guidelines section. I would urge you to read it and discuss your options with your care giver. Good Luck!


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