| Pregnancy, Pediatrics
and HIV Infection: Guidelines for Your Practice Page 10 |
| Case Scenario 1: A pregnant woman without prior antiretroviral therapy |
| For this woman, it is necessary to consider combination therapy based on her CD4 count and viral load. If she has a viral load of less than 10,000 and a CD4 greater than 500, AZT is recommended. If her viral load is greater than 10,000 and her CD4 count is less than 500, highly active antiretroviral therapy (HAART), including AZT as combination therapy, is recommended. When possible, therapy should be deferred to the second trimester. If her viral load at term is greater than 1000 copies/ml close to the expected due date (EDC), Cesarean section should be considered. When possible, therapy should be deferred to the second trimester. |
 |
| Case Scenario 2: A pregnant woman who is already on antiretroviral therapy |
| If clinically feasible, it is important to consider discontinuation of potentially teratogenic medications such as efavirenz or amprenavir to women in this category. It is also important to discuss the safety of drugs used in pregnancy and their potential toxicity during pregnancy (i.e. lactic acidosis) and to evaluate her ability to adhere to a regimen. Furthermore, we need to evaluate the woman's ability to adhere to her regimen since this could effect future antiretroviral options. If the woman is already on antiretroviral therapy and her viral load is less than 10,000 it may be possible to maintain the same regimen unless there is concern for toxicity or teratogenicity or unless it would be appropriate to add AZT to the regimen. AZT is the only antiretroviral drug available for intrapartum IV dosing, therefore it should be offered to all pregnant women unless there is an absolute contraindication. |
|
|