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Please Help! Pregnant and worried
Apr 15, 2005

I am hiv+ and am pregnant with my second child. While pregnant with my first child I was on Combivir, Viracept, and then Viramune at the very end of my pregnancy. My viral load was 5,000 before birth so I had a c-section to minimize the mother-to-fetus risk. My 1st child is negative but I'm worried about transmitting the virus to my second child. I recently had a genotype done which said I was resistant to 3TC, Viracept and Viramune. Are there other drug combinations I can take while I'm pregnant to decrease the risk? Also what are the chances of me transmitting the virus to my baby if I'm on antiviral drugs, my viral load is NOT undetectable, and I decide to have a c-section? Also my levels are cd4 550, viral load 7,000, and I'm not currently on any meds.

Response from Dr. Luzuriaga

With a CD4 of 550 and viral load of 7000, the current guidelines would not recommend therapy for a non-pregnent woman. However, to minimize the risk of mother-to-child transmission, most experts would recommend antiviral therapy to bring your viral load to undetectable levels. In addition, if you get your viral load under 1000, a cesarian section would not be indicated.

I would urge you to review your options with your care provider. Again, the best thing that you can do is to suppress your virus to undetectable levels and there are still several possible regimens that would allow you to do this. Maternal therapy allows transfer of the antivirals to the baby, which is also protective. I would not rely on cesarian section alone -- you may go into labor before it can be done and the baby is still exposed to your blood.


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