Our doctor has recommended AZT & 3TC at 33 weeks gestation, with possibly adding nevaripine near delivery by C-section. I asked him why start so late and he answered "if we start earlier, she may have to take the drugs indefinatly". How likely is this and what if we started treatment at say, 24 weeks? Her CD4 is 438, VL 200,000 at 8 weeks pregnant. But, it took the lab 2 weeks to finish the VL when doctor ordered, if the sample was not properly stored (2weeks before), could this effect VL? Thank you.

I'll first address your question regarding how handling and storage of blood samples might affect the results of viral load tests. Most laboratories will separate and freeze plasma if they do not run the specimens immediately. So, even if the specimens are not run immediately, the results would be very similar to a "fresh" sample.

The current guidelines for treatment during pregnancy are available in the "Guidelines" area of the "Treatment" section of this web site. Optimizing maternal health and prevention of mother-to-child transmission are 2 important considerations in determining a treatment regimen for a pregnant HIV positive woman. Most experts would recommend starting therapy in any individual with a viral load of 200,000, even with a normal CD4 count. Since the risk of mother-to-child transmission increases with increasing viral load (and is < 1% if viral load is < 1000), most experts would recommend a regimen that reduces viral load to < 1000. With a viral load of 200,000, I would recommend that you start antiretroviral therapy now -- I would not wait until 33 weeks. If your viral load does fall below 1000, a C-section would not be recommended.

KL