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

You answered:

C Start stavudine (Zerit) plus lamivudine (Epivir) plus nelfinavir (Viracept). Consider switching stavudine to zidovudine (Retrovir) if the anemia improves significantly.

This answer is correct. Combination antiretroviral therapy is indicated for a pregnant woman who meets treatment criteria for her own health or who has an HIV RNA greater than 1000 copies/ml. Nelfinavir is considered a preferred protease inhibitor during pregnancy because of extensive experience, proven efficacy, a good safety record, and adequate pharmacokinetic data. Zidovudine is relatively contraindicated due to severe anemia. Stavudine is an alternative NRTI agent in pregnancy that may be considered instead of zidovudine for women with severe anemia. If, however, the anemia significantly improves, zidovudine should then replace stavudine.

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