Question | Discussion | References

Prevention of Mother to Child Transmission of HIV (PMTCT) during Antenatal Care

You answered:

B Nevirapine should be avoided unless this woman's CD4 count is known to be below 500 cells/mm3.

This answer is incorrect. WHO Guidelines state that nevirapine initiation is not recommended for women with CD4 counts greater than 350 cells/mm3, due to an increased risk of hepatotoxicity and hypersensitivity. Nevirapine continues to be used extensively in resource-limited settings among pregnant women and has been generally well tolerated. Therefore, initiation of nevirapine with close monitoring may be considered for pregnant women if CD4 testing is not available and efavirenz is unavailable or contraindicated.

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A She should not be given efavirenz at any time during pregnancy given its risk of teratogenicity.
B A Cesarean section should be planned at delivery in order to reduce the risk of HIV transmission to her infant.
D She should start triple antiretroviral therapy immediately and a CD4 count should be checked if possible.

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