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Justice
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A 25-year-old woman who has been documented to be HIV positive for 2 years is in the eighth week of her first pregnancy. She is asymptomatic. CD4 cell counts have consistently been greater than 700/μL, and plasma HIV RNA viral loads have been undetectable. The patient has never taken antiretroviral medications.
Which of the following is the most appropriate management during her pregnancy?
A. Begin a three-drug antiretroviral regimen, including efavirenz, now
B. Begin a three-drug antiretroviral regimen, including zidovudine, now
C. Antiretroviral therapy is not needed because of the undetectable HIV RNA viral load
D. Administer nevirapine as a single drug at the time of delivery
E. Begin zidovudine as a single drug during her second trimester
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| DrVirgo
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E. Begin zidovudine as a single drug during her second trimester
Treating the HIV+ mom reduces the risk of transmission of HIV by 66% or 2/3rd.
(not sure about WHEN -which trimester to start, -second or first? )
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| Markus2009
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E---------> AZT during pregnancy, intrapartum and post-partum decreases the risk of vertical transmission from 25% to 8%.
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| peter90036
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"HIV RNA viral loads have been undetectable" --> no need for full treatment
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| CocaCola
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Markus2009 wrote:
E---------> AZT during pregnancy, intrapartum and post-partum decreases the risk of vertical transmission from 25% to 8%.
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| Justice
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OK, colleagues, I am posting correct answers. Thanks to everyone who voted.
The correct answer is E
Antiretroviral therapy during pregnancy has been proved to be unequivocally effective in reducing vertical transmission of HIV infection. When such therapy is combined with the judicious use of cesarean section, the infection rate for newborns in the United States has dropped below 3%. This patient has satisfactory CD4 cell counts and viral load levels and, if not pregnant, would not require antiretroviral therapy. However, treatment is indicated to further reduce the already low risk of vertical transmission. Despite her low viral load, this patient should receive zidovudine monotherapy, beginning between weeks 14 and 34 of pregnancy.
Antiretroviral therapy should be avoided during the first trimester unless there is a compelling reason to begin (or continue) such therapy. This asymptomatic woman with early-stage infection has no indications for first-trimester therapy. Moreover, efavirenz has been shown to be teratogenic in animals. Nevirapine alone at the time of delivery is effective in reducing the vertical transmission rate but is not as effective as standard treatment begun earlier in the pregnancy.
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| inkspot
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If a mother is on HIV medications and has a CD4 count of 275, which medications do you continue or discontinue? Continue all meds except effavirenz.
What about if her CD count was >500? Only continue AZT throughout 2nd and 3rd TM and 6 weeks postpartum.
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