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Case 1: Antiretroviral Therapy During Pregnancy to Prevent Perinatal HIV Transmission

You answered:

A No antiretroviral therapy is indicated at this stage of the pregnancy. Consider starting antiretroviral therapy if the mother’s HIV RNA increases to greater than 50,000 copies/ml.

This answer is incorrect. Although this patient does not yet meet criteria for initiating antiretroviral therapy for her own health, antiretroviral therapy is indicated to reduce the risk of perinatal transmission.

Choose another answer:

B Start zidovudine plus lamivudine (Combivir) plus nevirapine (Viramune). Consider switching nevirapine to efavirenz (Sustiva) if she does not tolerate nevirapine.
C Start stavudine (Zerit) plus lamivudine (Epivir) plus nelfinavir (Viracept). Consider switching stavudine to zidovudine (Retrovir) if the anemia improves significantly.
D Start zidovudine (Retrovir) monotherapy. Consider adding lamivudine (Epivir) in the third trimester.
E Start stavudine (Zerit) plus didanosine (Videx EC) plus nelfinavir (Viracept).

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