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

You answered:

D Start zidovudine (Retrovir) monotherapy. Consider adding lamivudine (Epivir) in the third trimester.

This answer is incorrect. Combination antiretroviral therapy is indicated in pregnancy in women who meet criteria for their own treatment or when they have a HIV-RNA greater than 1000 copies/ml.

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.
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.
E Start stavudine (Zerit) plus didanosine (Videx EC) plus nelfinavir (Viracept).

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