Question

Will prevention of mother to child transmission (PMTCT) drugs harm my baby?

11 June 2010. Related: All topics, Children, Newly diagnosed, Pregnancy, Starting treatment.

A week ago I was diagnosed with HIV-1 during a routine pregnancy testing. I have been told that I will need to go on treatment to stop infection on the baby. I have been told I will be on zidovudine (AZT), lamivudine (3TC) and Kaletra (liponavir and ritonavir). I’m concerned that it is too much and will affect the baby if I develop resistance.

The doctor said that she was happy with my CD4 count of 368 and I would not have had to take medication yet. Does that mean I stop meds after pregnancy or do I continue on these for life?

Answer

Answer: Charlotte Walker

Thank you for your question.

It is always difficult finding out you are HIV positive. Finding out when you are pregnant can be a lot to take in all at once.  Rest assured you are not alone. Many HIV positive women take HIV medication and go on to have perfectly normal, healthy children who are HIV negative.

The medication you have been prescribed is the correct combination for use during pregnancy. It has been tested and studied and there is no danger to your baby if you take this medicine. I understand that it sounds like a lot of medication but to avoid resistance it is important to take 3 drugs (triple therapy) at once. If you just take one drug then you would be in danger of getting resistance.

Your CD4 count is good. Your doctor is right that if you were not pregnant you may not need to go on medication straight away. The current recommendations are to start medication when the CD4 count is around 350.

During pregnancy, women who have a higher CD4 count can use Short-term Triple Antiretroviral Therapy (START) but this depends on your viral load. Treatment needs to be started early enough for your viral load to be undetectable when you give birth.

With START, treatment is usually started 20-28 weeks into the pregnancy and stopped after delivery. Some women decide to stay on treatment though, because they find it easy to take, and because they only would get q short break before they need to start again based on their CD4 count. This is a personal choice.

It is common for some women to find their CD4 count drops slightly during pregnancy. Normally it goes up again once the baby is born. As your CD4 count is close to the recommended starting point for medication, you may find that your doctor will suggest you continue with the medication even after the baby is born.

The most important thing to focus on now is the health of yourself and your baby. You did not mention what your viral load is or how far along in the pregnancy you are. By taking the HIV medication as your doctor prescribed you should see your viral load decrease to undetectable levels. The lower your viral load is the better it is for both you and the baby.

For general information on ‘HIV, pregnancy and women’s health’ please see this link. For more specific information on treatment during pregnancy and which drugs are best for use during pregnancy please follow these links.

If you would like to know more about zidovudine, lamivudine and Kaletra for your own health then please follow these links.