Question
My viral load increased in my third trimester – what should I do?
5 May 2011. Related: All topics, CD4 and viral load, Pregnancy.
Hi,
I am in my 36th week of pregnancy and have discovered through doing some tests that my viral load has increased from less than 20 to over 19,000. I need advice as to whether it would be safe to have the baby as soon as possible and what the risks are of the baby being infected. I’m really worried as I feel the longer I wait, the higher the rsk of the baby being infected. Thank you
Answer
Thank you for your question.
I understand why you are worried as 19,000 is much higher than a blip.
You need to firstly speak to your doctor about a repeat test just to confirm these are your results. Your choice depend on which drugs you are currently taking and what is available to you. Then you need to talk to your doctor about the possibility of either changing your meds or adding another drug to them to reduce the viral load.
If your are currently taking an NNRTI (nevirapine or efavirenz) this will involved changing to a PI. If you are already on a PI then you may ned to increase the dose. Lopinavir/ritonavir (Kaletra, also called Aluvia) is widely used during pregnancy but drug levels can be reduced in the third trimester.
It is impossible to say exactly what the risks to the baby are. However, the longer you have a high viral load the more the risk increases and so it is very important that you speak to your doctor about your treatment options immediately.
Having your baby 6 weeks early could put it at risk of other complications. It is best to try to adjust your treatment to reduce your viral load before delivery.
To enable me to answer this question more accurately it would help if you could please answer the following questions – Which treatment are you currently taking? How long have you been taking it? Are you only needing treatment for pregnancy or are you on treatment for your own health? What is your CD4 count? Has it gone down as the viral load increased?
Good luck with the rest of the pregnancy and please let us know how you get on.
Hi Portia,
If your viral load has risen to 15,500 it’s very likely that the medication that you’re taking isn’t working. You’ll need to talk to your doctor about changing treatment. This is important due to you being pregnant.
If you get your viral load back under control the risk to your baby will be drastically reduced. However, if you don’t there are ways in which your doctor can help you. Please see here: http://i-base.info/guides/pregnancy
I also have a similar problem where my viral load has gone up to 15500 and my cd4 count is 545, I am 31 weeks pregnant and i have been taking Trenvir if i should start changing the meds now how much guarantee will i have that the baby will not be exposed.