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Desperate
Feb 5, 2005

I am 1 month pregnant and just realised I am positive with a VL of 60, 000 copies: I know that is high but I would like to know if that is too much for the baby's heatth

Response from Dr. Luzuriaga

You are still early in your pregnancy and there is a lot that you can do to optimize your health and your baby's health. Since the diagnosis is still new to you, I would urge you to learn as much as you can about HIV (particularly HIV and pregnancy), so that you can discuss your options with your caregiver. A good place to start is with the Guidelines for the Use of Antiretrovirals During Pregnancy, available on this website under the "Treatment Guidelines" section. This document explains many aspects of pregnancy and how to optimize moms' and their babies' health.

In the absence of antiviral therapy, about 25-30% of women will transmit the virus to their baby; the risk of transmission increases with increasing viral load. Antivirals can markedly reduce the risk of transmission -- the risk of transmission when mom's viral load is undetectable is < 1%. So, most experts recommend the use of an antiviral regimen to prevent mother-to-child HIV transmission.

The choice of a regimen depends on many factors, including the maternal clinical condition, viral load, and CD4+ count. You don't mention your CD4+ T cell count but with a viral load of 60,000, most experts would recommend therapy to reduce your viral load as much as possible and to help keep you well. This plus doses of antivirals to you around delivery and to the baby after birth, will minimize the risk of transmitting the virus to your baby. Your doctor might want to check your virus for possible resistance to any antivirals before he/she starts therapy.

Our experience thus far indicates that antivirals are safe to administer throughout pregnancy. The only antiviral not currently recommended for administration during pregnancy is efavirenz (Sustiva). I would urge you to discuss your options with your doctor.

If you have questions as you go along, please be sure to write again. Good luck!


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