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HIV+ - want to have a baby
Jun 30, 2005

I am 30 years old, living in South Africa, HIV+ for 9 years now. CD4 count is 415 and viral load 950. I have been on Kaletra and Sustiva for a year now. My husband and I are considering having a baby. I have discussed with my doctor and he says my numbers are fine and has given us the go ahead although he says he will have to change the Sustiva and put me on viramune. All I want really is a second opinion. Do you think the numbers are fine? Generally I am in good health. Please help me doctor - I am not questioning my doctor - just seeking a second opinion on this.

Response from Dr. Luzuriaga

WIth a viral load of 950, your risk of transmitting the virus to the baby is much reduced but not nil. Since Sustiva has been associated with birth defects, it is not generally recommended for use during pregnancy and most providers would recommend a medication regimen change for a woman contemplating pregnancy (as your doctor has).

Since you are considering a regimen change, I would recommend trying to get your viral laod to under 400 copies/ml, which would fruther lower your risk of transmission to < 1%. Your medication and viral load histories would be very helpful in guiding the choice of a new regimen. If EFV/LPV is your first regimen, you might consider AZT/3TC plus Lopinavir. If you have had prior therapy, you should consider resistance testing, if available. (This may be harder to do with a viral load < 1000, depending on the method used).

The US Recommendations for the Use of Antiviral Agents During Pregnancy are available on this web site. This document is a great resource for information on how best to reduce the risk of mother-to-child transmission of the virus and ART's and their potential toxicities. It discusses suggested regimens for various scenarios. If you haven't already read it, I would urge you to do so -- it may be very helpful to you as you and your care provider work out what's best for you and your baby.


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