Pregnancy, Pediatrics and HIV Infection:  Guidelines for Your Practice

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Case Scenario 3: A woman in labor with no prior treatment and unknown HIV status
HIV counseling and a rapid test are essential for this woman. Therapy should be based on the results of the rapid test. There are 4 possible regimens available for women who have had no prior antiretroviral therapy who present in labor.  The options are as follows:
  1. Intrapartum intravenous (IV) loading dose of ZDV of 2 mg/kg over 1 hour, then 1 mg/kg/hr until delivery. (Beginning 8-12 hours after birth, newborns are given ZDV syrup 2 mg/kg every 6 hours for 6 weeks.)
  2. 600 mg of ZDV at the onset of labor followed by 300 mg every 3 hours until delivery and 150 mg of lamivudine (3TC) at the onset of labor followed by 150 mg of 3TC every 12 hours postdelivery. (Newborns are given ZDV syrup, 4 mg/kg and 3TC 2 mg/kg every 12 hours for 7 days.)
  3. A single dose of 200 mg of nevirapine at the onset of labor. (At age 48-72 hours, newborns receive a single dose of nevirapine 2 mg/kg.)
  4. An IV loading dose of ZDV of 2 mg/kg over 1 hour, then 1 mg/kg/hr until delivery and a single dose of nevirapine 200 mg at the onset of labor. (At age 48-72 hours, newborns are given ZDV syrup 2 mg/kg every 6 hours for 6 weeks and a single dose of nevirapine 2 mg/kg.)
It is important that all providers recognize that the use of nevirapine monotherapy has been associated with development of resistance, which could hinder the woman's response to this class of antiretroviral in the future. Most of the reported cases have been observed among women with high viral load. Therefore, close surveillance of these women including determination of CD4 viral load postpartum and initiation of therapy when appropriate is recommended. Evaluation of therapeutic options for this group is currently under investigation. Providers are encouraged to seek consultation with an expert in perinatal HIV transmission
 

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