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Alternatives to PACTG 076
May 18, 2006

I have been HIV+ 15 years. I was drug naive until I began HAART, a combination of Nevirapine, Abacavir and 3tc. I am perfectly adherent to this regimen, accomplishing 9 years of complete viral suppression. With self-insemination, my sero-negative husband and I are excited that I am nearing the seventh month pregnant with no adverse events so far. Question: with ZDV resistant HIV, what are some alternatives to the typical oral administration of ZDV to mother and child? Are there studies you can indicate that will support your responses/give me leads to follow? I am in Oregon, with doctors who have not experienced a self-advocating patient like myself.(Please do not reply to question after 07/15/06 as I will need answers before then.)

Response from Dr. Sullivan

Mother to child transmission of HIV is directly related to maternal viral load and studies have shown that when viral load is in excess of 100,000 copies/ml the risk of transmission is greater than 50% and the risk of transmission when the viral load is less than 1000 copies/ml is less than 1%. Because your viral load is undetectable your risk is less than 1%. There are no studies, in pregnant women with undetectable viral loads, to determine if additional treatment of the mother and baby around the time of delivery can further reduce the risk of transmission because the transmission rate is already less than 1% and it would take a study of several thousand HIV pregnant women to show a further reduction. That being said, I would give consideration to dosing your baby at birth with a short course of an antiretroviral drug, for example a single dose of tenofovir given around the time of birth. This is being done to protect the infant from infection if the baby is exposed to virus that might be present in the vaginal canal. A single dose of drug is usually very safe and well tolerated. You should discuss this and other options with your HIV care provider and your obstetrician. The good news is that with an undetectable viral load the chance of having a uninfected baby is greater than 99%. JLS.


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