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Case 2: Presentation in Labor with No Prior Antiretroviral Therapy

You answered:

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.

This answer is incorrect. In this setting, maternal prophylaxis with intravenous zidovudine followed by newborn prophylaxis with zidovudine is indicated and is associated with better efficacy when compared with newborn prophylaxis alone in preventing maternal-to-child HIV transmission. In addition, in the United States, most experts would recommend giving 6 weeks of zidovudine for post-natal antiretroviral therapy rather than single-dose nevirapine.

Choose another answer:

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.
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.

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