Question | Discussion | References | CME Credit

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

You answered:

B Start zidovudine plus lamivudine (Combivir) plus nevirapine (Viramune). Consider switching nevirapine to efavirenz (Sustiva) if she does not tolerate nevirapine.

This answer is incorrect. Women with CD4 counts greater than 350 cells/mm3 have an increased risk of developing symptomatic and possible life-threatening hepatotoxicity when initiating a nevirapine-containing antiretroviral regimen. Thus, nevirapine should be avoided when antiretroviral therapy is started in women who have a CD4 count greater than 350 cells/mm3. In general, efavirenz should not be used during pregnancy because of potential teratogenic effects. Zidovudine is relatively contraindicated due to severe anemia.

Choose another answer:

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.
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).

[Back to Case 1 Question | Go to Correct Answer]