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

Author: Jean R. Anderson , MD

Case last updated: February 13, 2006

A 27-year-old woman is diagnosed with asymptomatic HIV in pregnancy. Her initial laboratory studies show a CD4 count of 504 cells/mm3 and a HIV RNA level of 24,335 copies/ml. Her hematocrit is 22%, and further evaluation of her anemia reveals hemoglobin AC (hemogloblin C trait) and evidence of iron deficiency anemia. An ultrasound shows a normal intrauterine pregnancy at 24 weeks gestation. Iron supplementation is initiated.

Which of the following antiretroviral management options should be recommended for this pregnant woman?

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.
D Start zidovudine (Retrovir) monotherapy. Consider adding lamivudine (Epivir) in the third trimester.
E Start stavudine (Zerit) plus didanosine (Videx EC) plus nelfinavir (Viracept).