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Resistant to AZT and pregnant
Feb 11, 2005

I am currently 14 weeks pregnant and on a combination of therapy; viread,epivir, and viracept. I have had HIV for 10 years and my viral load is undectable. A resistance test indicated that I am resistant to AZT. Also, Nevirapine has caused a drug induced hepatitis in the past. What are my best choices in medication for myself and baby, to reduce transmission at the time of delivery? And all info indicates that if vaginal birth is done, labor should be short- any hints on how that is to happen?

Response from Dr. Luzuriaga

The only antiviral that is not generally recommended for uyse during pregnancy is efavirenz (Sustiva). If you are tolerating your current regimen and your viral load is undetectable, many experts would recommend that you continue it. With an undetecatble viral load, the risk of transmission is under 1-2%. Because the risk of transmission is so low, Cesarean section for the sole purpose of preventing HIV transmission is not generally recommended for women with undetectable viral loads.

If you continue to tolerate your regimen, we would recommend that you receive it through labor, delivery, and the post-partum period. Prophylaxis of your baby will also be important -- 3TC is transferred readily across the placenta but nelfinavir isn't (we don't know how much tenofovir is transferred). AZT is generally recommended for administration to women during delivery and after birth to their infants. You don't mention what resistance mutations were found in your virus, but if high level resistance mutations were found, you might also consider adding nevirapine. Hepatitis is unlikely with a single dose but if you have had trouble in the past, an alternative would be to give the baby a dose of nevirapine as soon as possible after birth , with another dose at 48-72 hours of age.

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