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Updated February 13, 2006

Case 2: Presentation in Labor with No Prior Antiretroviral Therapy

Author: Jean R. Anderson, MD

A 24-year-old P0 woman presents in early labor with no prenatal care. She has a history of injection drug use and a toxicology screen is positive for cocaine. After obtaining informed consent, a rapid HIV test is performed and is positive. On examination she has a 4 cm dilated cervix with regular uterine contractions and normal fetal heart tones.

Which of the following interventions is recommended to reduce the risk of mother-to-child transmission of HIV for this HIV-infected woman in labor who has received no prior antiretroviral therapy?

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.
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.