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Case 2: Presentation in Labor with No Prior Antiretroviral Therapy

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C Give the mother a single dose of a combination antiretroviral therapy consisting of oral zidovudine plus lamivudine (Combivir) plus nelfinavir (Viracept) and then allow her to deliver vaginally. The newborn does not need antiretroviral therapy since the mother will have received antiretroviral therapy prior to the delivery.

This answer is incorrect. Although this regimen may result in an acute decrease in plasma HIV RNA level, which may have some benefit in reducing HIV transmission, it has not been evaluated in clinical trials and should not be used given the availability of other regimens with proven efficacy. Most experts would instead recommend giving the mother intravenous zidovudine. In addition, the newborn should receive zidovudine for 6 weeks.

A It is too late to offer antiretroviral therapy for the mother. She should be allowed to deliver vaginally and the newborn should receive oral zidovudine (Retrovir) for 6 weeks.
B Begin zidovudine (Retrovir) by intravenous infusion, allow the mother to deliver vaginally, and give the newborn oral zidovudine for 6 weeks.
D It is too late to offer antiretroviral therapy for the mother. Allow the mother to deliver vaginally and give the newborn infant a single dose of nevirapine (Viramune) within 48-72 hours of birth.

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