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I'm so confused!!
Oct 18, 2001

My sister found out she was HIV+ during her 7th month of pregnancy and started taking Combivir. We have since found out that the partners that her husband were with came back negative and it has been a year since he was with them, so if they were positive the test would have been positive by now--my question is how did she get it then? She didn't do drugs or use needles or anything, I'm so confused. Also what are the chances the baby will be HIV+, I know it is in God's hands but I wondering if there is like a percentage as to how many babies are born postive to and HIV+ mom that just found out and didn't start taking med until the 7th month?

Response from Dr. Aberg

It doesn't really matter how your sister acquired HIV. Maybe this is a topic that she does not feel comfortable talking to you about. The issue at hand is her pregnancy. Without HIV therapy during pregnancy, the chances of the baby becoming HIV positive range on average from 25-40%. This varies depending on the overall health of the mother, the amount of HIV in the mother's blood, duration of labor (time of ruptured membranes) and type of delivery. There are other factors which may increase or decrease the risk of transmission.

Most experts currently recommend that pregnant women take a 3 drug regimen such as Combivir (AZT and 3TC) plus a protease inhibitor or a non-nucleoside such as nevirapine. Efavirenz is not recommended during pregnancy as it was associated with birth defects in a study involving monkeys. There is insufficient data as to whether efavirenz can be used during human pregnancies but it is not approved for use during pregnancy and I would not prescribe it during pregnancy.

The lower the mother's plasma viral load (amount of HIV in the blood), the less likely it is to transmit the virus to the baby. Some studies have shown the risk to be less than 2% if the mother's viral load is less than 50 copies/ml (undetectable) at time of delivery. This can be achieved in some women even starting as late as 7 months. Even just taking HIV medications during labor can reduce the risk to the baby. Ideally, we would like to start HIV meds earlier.

My best advice to you is to be very supportive of your sister. This is a scary and anxious time for her. Be there for her and her baby.


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