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HIV Life >> Women

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hopeful
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hiv+ Moms w/child
      #42124 - 10/21/02 01:05 PM

Hello,
What medication has the dr put you on? How do you feel? Do you take your medication regularly? How much risk is there in having a baby?
I like to thank you all for your replys in advance!!



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Anonymous
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Re: hiv+ Moms w/child new
      #42239 - 10/23/02 11:14 AM

The studies say there is little additional risk for an HIV positive woman who has an undetectable viral load...the problem is if you have a high viral load...it makes it harder for you and for the baby...you can more easily transmit HIV.

THIS is a report from Project Inform:
A recent and highly celebrated study (HIVNet 012) showed that one dose of nevirapine (Viramune) given to a woman in labor and one dose given to the newborn within the first 72 hours can reduce the risk of mother-to-child HIV transmission by about 50%. A new study shows that, when the two-course nevirapine regimen is added on top of other anti-HIV regimens commonly used during pregnancy (including AZT, AZT+3TC, and other combinations with and without a protease inhibitor), it offers no additional or unique preventive benefit. Thus, nevirapine is not needed if the HIV-positive woman is already on an effective HAART regimen, but it has clear value when used alone as a simple two-dose regimen for reducing the risk of transmission.
Theses days, use of powerful anti-HIV therapies have helped make transmission of HIV from mother to child a rarity. However, at the same time, there have been several cases of mother-to-child transmission of drug-resistant HIV, including multi-drug resistant HIV. Most of these have occurred in the setting of detectable viral load or high viral load during pregnancy, despite the use of anti-HIV therapies.

A few studies explored concerns about the prevalence and effect of drug resistance during pregnancy. One found that resistance to AZT at time of delivery was common among those who had received the drug prior to pregnancy. After adjusting for maternal viral load, CD4+ cell count and duration of labor, it also found that AZT resistance was independently linked to an increased risk of HIV vertical transmission. Additionally, the nevirapine study discussed above also found that resistance mutations associated with nevirapine at the time of delivery and six weeks after are common and may increase with lower CD4+ cell count (below 400). It also found that resistance to reverse transcriptase inhibitors and protease inhibitors were common. It is unknown whether resistance to these drugs increases risk of HIV transmission.

While there is still a lot to learn about the prevalence and risks of resistance during pregnancy, it remains an important concern. The prognosis for babies born with drug-resistant virus is poor. Pregnant women who are taking anti-HIV therapies, especially before pregnancy, are now encouraged to undergo a resistance test. This will help women and their doctors construct the most effective anti-HIV regimen in the course of pregnancy, minimizing potential risks linked to drug resistance, including the potential increased risk of mother-to-child HIV transmission.

Finally, a European study investigated the impact of pregnancy on CD4+ cell counts in women that became pregnant in the course of the study. All women had a known date of when they became HIV-positive (seroconversion). The study found that pregnant women had slightly lower CD4+ cell counts than non-pregnant women (401 vs. 450). In general, pregnant women have lower CD4+ cell counts than women who are not pregnant. During pregnancy CD4+ cell counts decline temporarily, but return to pre-pregnancy levels after the child is born. This return to pre-pregnancy CD4+ cell levels occurred in this study as well. These results suggest that pregnancy -- and potentially hormonal changes that occur therein -- does impact CD4+ cell count, though they do not seem to have an overall negative impact on HIV disease progression rates.

Also check out the answers in the expert forum on this site:
Continuation of therapy is generally advised in order to maximize maternal health and prevent transmission of the virus to the baby. Onlly one of the widely-used antivirals (Efavirenz) is generally not recommended during pregnancy. Women with viral loads of less than 1000 on therapy have an overall risk of less than 1% of transmitting the virus to their babies ( lower than the risk of transmitting many of the more common genetic disorders). For more information, you might wish to read the Guidelines for the Use of Antiretroviral Agents During Pregnancy , available on this web site.



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