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Is She or Isn't She?
An HIV-infected pregnant woman says she's taking her antiretrovirals — but the blood test results say otherwise. How would you manage?
A woman in her 30s entered the clinic, 16 weeks pregnant, to reestablish care for her HIV infection and to start antiretroviral therapy (ART), having previously refused on multiple occasions. Her CD4 count was 237 cells/mm3, and her CD4 percentage was 34% — both stable since her diagnosis in 2007. Her viral load was 427 copies/mL. She was started on AZT/3TC (Combivir) + lopinavir/ritonavir (Kaletra).
One month later, she reported taking her medications daily, but her viral load had not dropped (now 468 copies/mL), and her CD4-cell count had not increased.
How would you manage this patient, both for her own health and for that of her infant?
Hear what the experts have to say
Two experts have now weighed in with their thoughts on management. View the discussion here.
Published in Journal Watch HIV/AIDS Clinical Care February 8, 2010
Reader Remarks:
Review and add to remarks on this article
- pregnancy and hiv
saka venkata satya prasadf, govt, 9 Feb 2010 1:41 PM EST
Its a common tale of most of the pregnant females.Firstly it is the fear that something would happen to her... [more] - Is she or isn't she?
Samar Assem Badreddine, Dubai, UAE, 11 Feb 2010 1:17 PM EST
The possibility of nonadherence must be considered. Assuming that she is adherent as she claims, possible explanations of lack of... [more] - counselling
maurizio setti, San Martino University Hospital, Genoa, Italy, 11 Feb 2010 1:17 PM EST
First: had the virus been genotyped before starting treatment? Assuming so, and that the drugs are active, you have to... [more] - is She or Isn't She: adherance to ART during pregnancy
Ibrahim Ghobrial, 11 Feb 2010 1:17 PM EST
1- She is on AZT. Macrocytosis will confirm compliance 2- Check for drug interactions or altered pharmacokinetics during pregnancy 3-... [more] - HIV in pregnancy
Charlie Moehs, 11 Feb 2010 1:17 PM EST
I wondered if first her genotype was done before starting therapy? Also what was her starting Viral Load? - Non-compliance
Cloete van Vuuren, Hospital, 11 Feb 2010 1:17 PM EST
She most likely is not taking her meds. Consider side effects (diarhoea with Kaletra), abusive relationship, mood disorder etc. If... [more] - Non compliant?
AE Sierra, 11 Feb 2010 1:17 PM EST
Gently but in context explain the findings to her. If no compliance confirmed or highly suspected: a) Use counselling by... [more] - antiretroviral therapy in pregnancy
bob a mcwilliam, carnarvon, WA, 11 Feb 2010 1:17 PM EST
If evidence bsaed medicine indicates a better chance of non infectivity of infant, this needs to be emphasised, but ultimately... [more] - Non Compliant? (2)
A. E. Sierra, 11 Feb 2010 1:18 PM EST
one caveat to my response above is that E.P. Acosta et Al reported in Antimicrobial Agents and Quimiotherapy 2004 Feb.... [more] - Non Compliant? (3)
A. E. Sierra, 11 Feb 2010 1:18 PM EST
If the patient lives in West Central Brazil or any other area with high incidence of resistant or tolerant HIV... [more] - GIVE HER BENEFIT OF DOUBT
IO AMEEN, 16 Feb 2010 8:01 AM EST
I PRESUME SHE IS CONCERNED ABOUT PMTCT HENCE THE DESIRE FOR THERAPY AT THIS TIME. THERE IS POSSIBILTY OF EMERGENCE... [more] - Nausae and vomiting?
Harsha Somaroo, South Africa, 17 Feb 2010 2:46 PM EST
Perhaps she is taking her medication, but is experiencing these side effects and thus the bioavailablity of the drugs might... [more] - is she or isn,t she?
daniela nikolova, clinic of infectious diseases, 22 Feb 2010 12:31 PM EST
One month is not enough period to fall down the VL and to increase CD4s.This pregnant woman is at 16... [more]
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